Provider Demographics
NPI:1467767228
Name:SHARON JOLLY & ASSOCIATES AUDIOLOGY, SPEECH LANGUAGE PATHOLOGY, PSYCHO
Entity type:Organization
Organization Name:SHARON JOLLY & ASSOCIATES AUDIOLOGY, SPEECH LANGUAGE PATHOLOGY, PSYCHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP A
Authorized Official - Phone:845-928-2579
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-0368
Mailing Address - Country:US
Mailing Address - Phone:845-928-2579
Mailing Address - Fax:845-928-2729
Practice Address - Street 1:66 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-3030
Practice Address - Country:US
Practice Address - Phone:845-928-2579
Practice Address - Fax:845-928-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency