Provider Demographics
NPI:1184936361
Name:SHARP, MELISSA (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FOLGER ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1623
Mailing Address - Country:US
Mailing Address - Phone:315-730-3778
Mailing Address - Fax:
Practice Address - Street 1:34 FOLGER ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1623
Practice Address - Country:US
Practice Address - Phone:315-730-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300307164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse