Healthcare Provider Details

I. General information

NPI: 1821191461
Provider Name (Legal Business Name): SHARON REYNOLDS PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 WALNUT ST
NEWTON MA
02459-1756
US

IV. Provider business mailing address

PO BOX 620024
NEWTON MA
02462-0024
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-0422
  • Fax: 617-332-0423
Mailing address:
  • Phone: 617-332-0422
  • Fax: 617-332-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN154473
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number154473
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: