Provider Demographics
NPI:1942741830
Name:PETROSKY, SHARON ANN (RBT)
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:ANN
Last Name:PETROSKY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1279 KAWAIHAE RD.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-491-9661
Mailing Address - Fax:800-991-6071
Practice Address - Street 1:65-1279 KAWAIHAE RD.
Practice Address - Street 2:SUITE 208
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743
Practice Address - Country:US
Practice Address - Phone:808-491-9661
Practice Address - Fax:800-991-6071
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician