Provider Demographics
NPI:1467146449
Name:REDONDO POLO, SHARON KATHLEM
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KATHLEM
Last Name:REDONDO POLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELMWOOD AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-4120
Mailing Address - Country:US
Mailing Address - Phone:585-271-0680
Mailing Address - Fax:
Practice Address - Street 1:100 ELMWOOD AVE STE 400
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-4120
Practice Address - Country:US
Practice Address - Phone:585-271-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist