Provider Demographics
NPI:1457391765
Name:EASTMAN, SHARON M (PA)
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:M
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:281 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3511
Mailing Address - Country:US
Mailing Address - Phone:508-226-2213
Mailing Address - Fax:508-431-2637
Practice Address - Street 1:588 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6057
Practice Address - Country:US
Practice Address - Phone:401-722-2400
Practice Address - Fax:401-728-3920
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780672709OtherGROUP NPI#
1780672709OtherGROUP NPI#
P21938Medicare UPIN