Provider Demographics
NPI:1518286400
Name:KEISCH, SHARON A
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:KEISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:A
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LACMAC,DIPLAC
Mailing Address - Street 1:17 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4109
Mailing Address - Country:US
Mailing Address - Phone:207-482-0725
Mailing Address - Fax:
Practice Address - Street 1:251 JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572
Practice Address - Country:US
Practice Address - Phone:207-482-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist