Provider Demographics
NPI:1578683777
Name:CHRISTOPHERSON, SHARON (MA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4410
Mailing Address - Country:US
Mailing Address - Phone:513-598-9444
Mailing Address - Fax:513-598-8223
Practice Address - Street 1:6570 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4410
Practice Address - Country:US
Practice Address - Phone:513-598-9444
Practice Address - Fax:513-598-8223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0346237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000358469OtherANTHEM PIN NUMBER
OHHA177OtherHUMANA PROVIDER NUMBER
OH2435845OtherUNITED HEALTHCARE
OH38370151801OtherWORKERS COMP
OH000000358469OtherANTHEM PIN NUMBER
OHCH4148941Medicare ID - Type UnspecifiedMEDICARE SELF