Provider Demographics
NPI:1710583984
Name:MCCOLGAN, SHARON ROME
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ROME
Last Name:MCCOLGAN
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 1:11677 HARBOUR LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2682
Mailing Address - Country:US
Mailing Address - Phone:440-877-9753
Mailing Address - Fax:
Practice Address - Street 1:11677 HARBOUR LIGHT DR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-2682
Practice Address - Country:US
Practice Address - Phone:440-877-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000264085376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1831506Medicaid