Healthcare Provider Details

I. General information

NPI: 1528008455
Provider Name (Legal Business Name): KAY C SHARP PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST GREEN ST
ITHACA NY
14850
US

IV. Provider business mailing address

278 BLACK OAK RD
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6200
  • Fax: 607-274-6224
Mailing address:
  • Phone: 607-274-6200
  • Fax: 607-274-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0121141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: