Provider Demographics
NPI:1619031093
Name:AXELROD, SHARON LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LEE
Last Name:AXELROD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ROUTE 23 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-831-1220
Mailing Address - Fax:973-831-0029
Practice Address - Street 1:51 ROUTE 23 SOUTH
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-831-1220
Practice Address - Fax:973-831-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000851-1231H00000X
NY14000006177231HA2500X
NJMG00753231HA2500X
NJ41YA00044500231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01179602Medicaid
NJ058240Medicare PIN