Provider Demographics
NPI:1548598907
Name:MIRAKIAN, SHARON (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MIRAKIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233B JAMISON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4282
Mailing Address - Country:US
Mailing Address - Phone:215-738-6646
Mailing Address - Fax:
Practice Address - Street 1:937 E HAVERFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3800
Practice Address - Country:US
Practice Address - Phone:610-525-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN289119L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN289119LOtherLICENSE