Provider Demographics
NPI:1346328788
Name:ROSE-REGO, SHARON (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:ROSE-REGO
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 1:6151 WILSON MILLS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2128
Mailing Address - Country:US
Mailing Address - Phone:440-781-9609
Mailing Address - Fax:
Practice Address - Street 1:6151 WILSON MILLS RD STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2128
Practice Address - Country:US
Practice Address - Phone:440-781-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5879103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP29731Medicare ID - Type Unspecified