Provider Demographics
NPI:1821183674
Name:SHARP, CHERYL A (AUD,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:SHARP
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N EDDY ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3096
Mailing Address - Country:US
Mailing Address - Phone:574-237-9200
Mailing Address - Fax:574-237-9383
Practice Address - Street 1:211 N EDDY ST.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3096
Practice Address - Country:US
Practice Address - Phone:574-237-9200
Practice Address - Fax:574-237-9383
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001872A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423490AMedicaid
IN000000294825OtherANTHEM
IN200938540Medicaid
IN200423490AMedicaid