Provider Demographics
NPI:1669959912
Name:MILLER, SHARON ELAINE (MAC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:ELAINE
Other - Last Name:CROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:298 PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3087
Mailing Address - Country:US
Mailing Address - Phone:304-283-7882
Mailing Address - Fax:
Practice Address - Street 1:115 AIKENS CTR STE 12
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6210
Practice Address - Country:US
Practice Address - Phone:304-283-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV96239OtherACUPUNCTURE LICENSE NUMBER