Provider Demographics
NPI:1942435607
Name:SHARON JOLLY AUDIOLOGY & SPEECH LANGUAGE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:SHARON JOLLY AUDIOLOGY & SPEECH LANGUAGE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SLP
Authorized Official - Phone:845-928-2579
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-0368
Mailing Address - Country:US
Mailing Address - Phone:845-928-2579
Mailing Address - Fax:
Practice Address - Street 1:450 GIDNEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3116
Practice Address - Country:US
Practice Address - Phone:845-928-2579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000043-1231H00000X
NY003002-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty