Healthcare Provider Details

I. General information

NPI: 1619031093
Provider Name (Legal Business Name): SHARON LEE AXELROD AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ROUTE 23 SOUTH
RIVERDALE NJ
07457
US

IV. Provider business mailing address

51 ROUTE 23 SOUTH
RIVERDALE NJ
07457
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-1220
  • Fax: 973-831-0029
Mailing address:
  • Phone: 973-831-1220
  • Fax: 973-831-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000851-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number14000006177
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberMG00753
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00044500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: