Provider Demographics
NPI:1336452994
Name:LEAVY, SHAREA ANGELA (HAD & SLP)
Entity Type:Individual
Prefix:
First Name:SHAREA
Middle Name:ANGELA
Last Name:LEAVY
Suffix:
Gender:F
Credentials:HAD & SLP
Other - Prefix:
Other - First Name:SHAREA
Other - Middle Name:ANGELA
Other - Last Name:MINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAD & SLP
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:PPE SUITE 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:410-823-8309
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:PPE SUITE 601
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8309
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01195231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist