Provider Demographics
NPI:1932443595
Name:WICKERSHAM, SHARON M (CT(ASCP))
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:WICKERSHAM
Suffix:
Gender:F
Credentials:CT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4536
Mailing Address - Country:US
Mailing Address - Phone:203-246-6748
Mailing Address - Fax:
Practice Address - Street 1:2015 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4536
Practice Address - Country:US
Practice Address - Phone:203-246-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000144-1246QC2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QC2700XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyCytotechnology