MEDICARE: SHARRIE COBURN PHD COSMETOLOGIST

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	174400000X	Specialist	COSM975647	OH

General Provider Information

NPI Number	:	1710325543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARRIE COBURN PHD COSMETOLOGIST

Provider Business Mailing Address
First Line	:	170 RICHMOND RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-1239
Country	:	US
Telephone Number	:	440-525-6755
Fax Number	:	440-969-6022

Provider Business Practice Location Address
First Line	:	170 RICHMOND RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-1239
Country	:	US
Telephone Number	:	440-525-6755
Fax Number	:	440-969-6022

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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