Provider Demographics
NPI:1720009509
Name:SPEAR, SHARON (RD CDE)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SPEAR
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:BYRNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-368-4560
Mailing Address - Fax:585-368-4565
Practice Address - Street 1:800 CARTER STREET
Practice Address - Street 2:WILSON HEALTH CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-338-1400
Practice Address - Fax:585-336-4845
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03215987Medicaid
NY03215987Medicaid
NYDD5523Medicare PIN