Provider Demographics
NPI:1942691092
Name:PEART, SHARON (PAS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PEART
Suffix:
Gender:F
Credentials:PAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 HIGHPOINT CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GEORGIA
Mailing Address - Zip Code:30078
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2703
Practice Address - Country:US
Practice Address - Phone:866-926-0035
Practice Address - Fax:646-867-7272
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1315103TH0100X, 163W00000X, 163WH0200X, 163WP0200X, 235Z00000X, 363A00000X, 372600000X, 3747P1801X, 374U00000X, 376K00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111161011110Medicaid
GA222113344346Medicaid
GA111832334799Medicaid