Provider Demographics
NPI:1922244490
Name:DAVIS, SHARON LYNN
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:DAVIS
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 1:4206 RETAMA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:361-582-0611
Mailing Address - Fax:361-582-0555
Practice Address - Street 1:4206 RETAMA CIRCLE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-582-0611
Practice Address - Fax:361-582-0555
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist