Provider Demographics
NPI:1689960163
Name:MAHONEY, SHARON (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HASWELL RD
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1302
Mailing Address - Country:US
Mailing Address - Phone:518-273-4911
Mailing Address - Fax:518-273-3312
Practice Address - Street 1:11 HASWELL ROAD
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189
Practice Address - Country:US
Practice Address - Phone:518-273-4911
Practice Address - Fax:518-273-3312
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist