Healthcare Provider Details

I. General information

NPI: 1861682577
Provider Name (Legal Business Name): SHARON RUTH NASSAU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2007
Last Update Date: 07/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 S GRAHAM RD
FLINT MI
48532-3535
US

IV. Provider business mailing address

1290 S GRAHAM RD
FLINT MI
48532-3535
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-1776
  • Fax: 810-733-1299
Mailing address:
  • Phone: 810-720-1776
  • Fax: 810-733-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301007929
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: