Provider Demographics
NPI:1942478334
Name:MOSS, SHARON ELIZABETH (PH D)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ELIZABETH
Last Name:MOSS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0237
Mailing Address - Country:US
Mailing Address - Phone:828-837-7220
Mailing Address - Fax:
Practice Address - Street 1:913 UPPER PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-9157
Practice Address - Country:US
Practice Address - Phone:828-837-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2812103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326 TOtherBCBS NORTH CAROLINA
NC6000350Medicaid
NC2821371Medicare PIN