Provider Demographics
NPI:1518255660
Name:GRESZLER, SHARON KIMBERLY (MPAS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KIMBERLY
Last Name:GRESZLER
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:KIMBERLY
Other - Last Name:WOLCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14305 PHOENIX RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1015
Mailing Address - Country:US
Mailing Address - Phone:216-346-5930
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005042363A00000X
NY014797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant