Provider Demographics
NPI:1619388469
Name:CLARK, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 COVE BRIDGE RD
Mailing Address - Street 2:101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8716
Mailing Address - Country:US
Mailing Address - Phone:919-332-2594
Mailing Address - Fax:919-373-0845
Practice Address - Street 1:1115 COVE BRIDGE RD
Practice Address - Street 2:101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-8716
Practice Address - Country:US
Practice Address - Phone:919-332-2594
Practice Address - Fax:919-373-0845
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor