Provider Demographics
NPI:1336811223
Name:SHARPTON, TEDDI JO (BA, LMBT)
Entity Type:Individual
Prefix:
First Name:TEDDI
Middle Name:JO
Last Name:SHARPTON
Suffix:
Gender:F
Credentials:BA, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 WHISKEY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-6607
Mailing Address - Country:US
Mailing Address - Phone:910-945-9600
Mailing Address - Fax:
Practice Address - Street 1:2149 WHISKEY BRANCH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-6607
Practice Address - Country:US
Practice Address - Phone:910-945-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist