Provider Demographics
NPI:1356427793
Name:PRYBYLO, SHARON AMBUSKE (DPT)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:AMBUSKE
Last Name:PRYBYLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FL ATKINS
Mailing Address - Street 2:601 MLK JR. DRIVE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27110-0001
Mailing Address - Country:US
Mailing Address - Phone:336-750-2199
Mailing Address - Fax:336-750-2192
Practice Address - Street 1:330 FL ATKINS
Practice Address - Street 2:601 MLK JR. DRIVE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27110-0001
Practice Address - Country:US
Practice Address - Phone:336-750-2199
Practice Address - Fax:336-750-2192
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07798OtherBCBS
NC346596Medicare ID - Type Unspecified