Provider Demographics
NPI:1992414379
Name:MESSECK, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MESSECK
Suffix:
Gender:F
Credentials:
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 121
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-0121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 S CHESTERFIELD RD
Practice Address - Street 2:SOUTH CHESTERFIELD RD
Practice Address - City:GOSHEN
Practice Address - State:MA
Practice Address - Zip Code:01032
Practice Address - Country:US
Practice Address - Phone:413-695-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN60862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA164W00000XOtherNURSING