Healthcare Provider Details

I. General information

NPI: 1023326196
Provider Name (Legal Business Name): SHARA ELIZABETH CYRUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 NEW YORK AVE NE
WASHINGTON DC
20002-3320
US

IV. Provider business mailing address

64 NEW YORK AVE NE
WASHINGTON DC
20002-3320
US

V. Phone/Fax

Practice location:
  • Phone: 202-763-9131
  • Fax:
Mailing address:
  • Phone: 202-763-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26515
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080503
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: