Provider Demographics
NPI:1801397492
Name:LAND, SHARRON RUTH
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:RUTH
Last Name:LAND
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 1:14715 BRISTOW RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3945
Mailing Address - Country:US
Mailing Address - Phone:703-753-1702
Mailing Address - Fax:
Practice Address - Street 1:8584 SEDGE WREN DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2996
Practice Address - Country:US
Practice Address - Phone:703-753-1702
Practice Address - Fax:703-753-4981
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty