Healthcare Provider Details

I. General information

NPI: 1427191394
Provider Name (Legal Business Name): SHARON J SKOLL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 CREEDMOOR RD SUITE 104
RALEIGH NC
27612-2310
US

IV. Provider business mailing address

5816 CREEDMOOR RD SUITE 104
RALEIGH NC
27612-2310
US

V. Phone/Fax

Practice location:
  • Phone: 919-665-4673
  • Fax: 919-882-8348
Mailing address:
  • Phone: 919-665-4673
  • Fax: 919-882-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012112
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3286
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: