Provider Demographics
NPI:1639584113
Name:SCUBLA, SHARON L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:SCUBLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2031
Mailing Address - Country:US
Mailing Address - Phone:604-339-5225
Mailing Address - Fax:
Practice Address - Street 1:604 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2031
Practice Address - Country:US
Practice Address - Phone:604-339-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027104-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4263288-00OtherNATION MASSAGE THERAPIST NUMBER