Provider Demographics
NPI:1821191461
Name:REYNOLDS, SHARON (PMHCNS)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620024
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-0024
Mailing Address - Country:US
Mailing Address - Phone:617-332-0422
Mailing Address - Fax:617-332-0423
Practice Address - Street 1:846 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1756
Practice Address - Country:US
Practice Address - Phone:617-332-0422
Practice Address - Fax:617-332-0423
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN154473364SP0809X
MA154473364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114322OtherCIGNA
MA110082000OtherMAGELLAN BEH HEALTH
7675042OtherAETNA
MA759696OtherTUFTS HEALTH PLAN
MA1006850OtherBEOEN HEALTH STRATEGIES
MAPN0360OtherBLUE CROSS BLUE SHIELD
MA1006850OtherBEOEN HEALTH STRATEGIES
NS0382Medicare ID - Type Unspecified