Healthcare Provider Details

I. General information

NPI: 1427142322
Provider Name (Legal Business Name): SHARON LYNNE TRESTON-MAGNACCA D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VIRGINIA DR
MILFORD MA
01757-2131
US

IV. Provider business mailing address

3 VIRGINIA DR
MILFORD MA
01757-2131
US

V. Phone/Fax

Practice location:
  • Phone: 508-331-2378
  • Fax:
Mailing address:
  • Phone: 508-331-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2103
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2103
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2103
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: