Provider Demographics
NPI:1891824009
Name:DOHERTY, SHARON LISA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LISA
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 WATER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-3439
Mailing Address - Country:US
Mailing Address - Phone:570-828-8256
Mailing Address - Fax:570-828-0836
Practice Address - Street 1:492 N FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1120
Practice Address - Country:US
Practice Address - Phone:201-327-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001023002255A2300X
PART0033432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer