Provider Demographics
NPI:1508963216
Name:DRAGOVICH, SHARON LYNN (CNS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:DRAGOVICH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RUSSO DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9666
Mailing Address - Country:US
Mailing Address - Phone:330-533-3890
Mailing Address - Fax:
Practice Address - Street 1:12616 SHARON LYNN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9134
Practice Address - Country:US
Practice Address - Phone:330-337-3301
Practice Address - Fax:330-337-3302
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH254350364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health