Healthcare Provider Details

I. General information

NPI: 1952300626
Provider Name (Legal Business Name): SHARON LYNN MONTGOMERY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 OLD FREEPORT RD 1A
PITTSBURGH PA
15238-3129
US

IV. Provider business mailing address

1601 MOTOR INN DR SUITE 240
GIRARD OH
44420-2420
US

V. Phone/Fax

Practice location:
  • Phone: 412-967-9220
  • Fax: 412-967-9303
Mailing address:
  • Phone: 330-759-6750
  • Fax: 330-759-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000920L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: