Provider Demographics
NPI:1831304989
Name:JAECKEL, SHARON A (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:A
Last Name:JAECKEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 MURRAY LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1924
Mailing Address - Country:US
Mailing Address - Phone:703-927-6960
Mailing Address - Fax:
Practice Address - Street 1:6802 MURRAY LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1924
Practice Address - Country:US
Practice Address - Phone:703-927-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist