Healthcare Provider Details

I. General information

NPI: 1790329977
Provider Name (Legal Business Name): SHARON BENTFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MORRISON AVE APT 3C
BRONX NY
10472-4286
US

IV. Provider business mailing address

1171 MORRISON AVE APT 3C
BRONX NY
10472-4286
US

V. Phone/Fax

Practice location:
  • Phone: 415-275-4237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: