Provider Demographics
NPI:1982041125
Name:DEFUSCO, SHARON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:DEFUSCO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEECHNUT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853
Mailing Address - Country:US
Mailing Address - Phone:908-507-3643
Mailing Address - Fax:
Practice Address - Street 1:17 BEECHNUT DRIVE
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853
Practice Address - Country:US
Practice Address - Phone:908-507-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00367400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist