Healthcare Provider Details

I. General information

NPI: 1336085976
Provider Name (Legal Business Name): SHARON STANIFORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 MAIN ST FL 4
MIDDLETOWN CT
06457-3360
US

IV. Provider business mailing address

386 MAIN ST FL 4
MIDDLETOWN CT
06457-3360
US

V. Phone/Fax

Practice location:
  • Phone: 443-216-9303
  • Fax:
Mailing address:
  • Phone: 443-216-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP16855
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: