Provider Demographics
NPI:1922580059
Name:PHELPS, SHARON ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:PHELPS
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 1:4920 REGENCY PL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-5959
Mailing Address - Country:US
Mailing Address - Phone:603-731-9108
Mailing Address - Fax:
Practice Address - Street 1:6437 RUCKER RD STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4868
Practice Address - Country:US
Practice Address - Phone:317-405-9016
Practice Address - Fax:888-654-4116
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist