Provider Demographics
NPI:1689797052
Name:EVANOFF-EASTMAN, SHARON ADELL
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ADELL
Last Name:EVANOFF-EASTMAN
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 1:3105 E AVENUE H6
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1613
Mailing Address - Country:US
Mailing Address - Phone:661-618-6342
Mailing Address - Fax:
Practice Address - Street 1:2689 SIERRA HIGHWAY
Practice Address - Street 2:BOX 1359
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560
Practice Address - Country:US
Practice Address - Phone:661-256-7208
Practice Address - Fax:661-256-7209
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator