Healthcare Provider Details

I. General information

NPI: 1205748076
Provider Name (Legal Business Name): IVORY SUTTON SHARP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S GODDARD BLVD APT 6153
KING OF PRUSSIA PA
19406-3466
US

IV. Provider business mailing address

580 S GODDARD BLVD # 580
KING OF PRUSSIA PA
19406-3270
US

V. Phone/Fax

Practice location:
  • Phone: 215-397-0771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: