Provider Demographics
NPI:1619022829
Name:REED, SHARON LEE (CERTIFIED MASTECTOMY)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEE
Last Name:REED
Suffix:
Gender:F
Credentials:CERTIFIED MASTECTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 HAMMOND HIGHLANDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-9141
Mailing Address - Country:US
Mailing Address - Phone:231-922-5982
Mailing Address - Fax:231-922-5982
Practice Address - Street 1:2615 HAMMOND HIGHLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9141
Practice Address - Country:US
Practice Address - Phone:231-922-5982
Practice Address - Fax:231-922-5982
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0540050256OtherBCBS
MI2867263Medicaid
MI2867263Medicaid