Healthcare Provider Details

I. General information

NPI: 1528770856
Provider Name (Legal Business Name): SHARON SOLEBO DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PARKER ST
MAYNARD MA
01754-2178
US

IV. Provider business mailing address

141 PARKER ST
MAYNARD MA
01754-2178
US

V. Phone/Fax

Practice location:
  • Phone: 866-991-2103
  • Fax: 888-971-4182
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP026821
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: