Healthcare Provider Details

I. General information

NPI: 1902887839
Provider Name (Legal Business Name): SHARON LEA GRESHAM MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6904 CRANBERRY DR
NEW PORT RICHEY FL
34653-4588
US

IV. Provider business mailing address

6904 CRANBERRY DR
NEW PORT RICHEY FL
34653-4588
US

V. Phone/Fax

Practice location:
  • Phone: 727-848-2167
  • Fax:
Mailing address:
  • Phone: 727-848-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003593
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA11551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: