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NPI Code Detail

MEDICARE: SHARON GANDY

MEDICARE:   SHARON  GANDY
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1831745058
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARON GANDY
Provider Business Mailing Address
First Line : 1101 W NORTH SHORE AVE APT 3
Second Line :
City : CHICAGO
State : IL
Zip : 60626-6713
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 N CLYBOURN AVE UNIT C105
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2295
Country : US
Telephone Number : 312-242-1665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 08/13/2019

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Directions to “ SHARON GANDY ” Practice Location

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