MEDICARE: MS. SHARON CALLAHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	3588	FL

General Provider Information

NPI Number	:	1467726489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON CALLAHAN

Provider Business Mailing Address
First Line	:	4137 NW 36TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-1444
Country	:	US
Telephone Number	:	352-378-0875
Fax Number	:	352-372-0016

Provider Business Practice Location Address
First Line	:	2630 NW 41ST ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7495
Country	:	US
Telephone Number	:	352-373-4236
Fax Number	:	352-372-0016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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