Healthcare Provider Details

I. General information

NPI: 1356427793
Provider Name (Legal Business Name): SHARON AMBUSKE PRYBYLO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FL ATKINS 601 MLK JR. DRIVE
WINSTON SALEM NC
27110-0001
US

IV. Provider business mailing address

330 FL ATKINS 601 MLK JR. DRIVE
WINSTON SALEM NC
27110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-750-2199
  • Fax: 336-750-2192
Mailing address:
  • Phone: 336-750-2199
  • Fax: 336-750-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier07798
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: