Provider Demographics
NPI:1326679705
Name:SADEH SHARVIT, SHIRI (PHD)
Entity Type:Individual
Prefix:
First Name:SHIRI
Middle Name:
Last Name:SADEH SHARVIT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 STEVENSON LN
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7601
Mailing Address - Country:US
Mailing Address - Phone:510-984-8132
Mailing Address - Fax:
Practice Address - Street 1:6535 N CHARLES ST STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5824
Practice Address - Country:US
Practice Address - Phone:410-427-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD718930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical