Healthcare Provider Details

I. General information

NPI: 1760655302
Provider Name (Legal Business Name): SHARON OLIVIA HOLDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON OLIVIA SAVOURY PA-C

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NEW BOSTON RD
BEDFORD NH
03110-4108
US

IV. Provider business mailing address

525 NEW BOSTON RD
BEDFORD NH
03110-4108
US

V. Phone/Fax

Practice location:
  • Phone: 781-454-9462
  • Fax:
Mailing address:
  • Phone: 781-454-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2482
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0863
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: