Provider Demographics
NPI:1659345593
Name:BRODIE, SHARON V (AT,C)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:V
Last Name:BRODIE
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 FOXWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7024
Mailing Address - Country:US
Mailing Address - Phone:518-280-6827
Mailing Address - Fax:
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3718
Practice Address - Country:US
Practice Address - Phone:518-489-2449
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000471390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program