Provider Demographics
NPI:1699400523
Name:ASHWORTH, SHARONDA SADIQ
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:SADIQ
Last Name:ASHWORTH
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 1:280 PARK PL # 322
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1791
Mailing Address - Country:US
Mailing Address - Phone:862-250-4270
Mailing Address - Fax:862-250-4270
Practice Address - Street 1:280 PARK PL # 322
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1791
Practice Address - Country:US
Practice Address - Phone:862-250-4270
Practice Address - Fax:862-250-4270
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy