Healthcare Provider Details

I. General information

NPI: 1730693763
Provider Name (Legal Business Name): SHARON HAMON-BOOMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200A TECHNOLOGY CT
CHANTILLY VA
20151-1214
US

IV. Provider business mailing address

4200A TECHNOLOGY CT
CHANTILLY VA
20151-1214
US

V. Phone/Fax

Practice location:
  • Phone: 703-927-6481
  • Fax:
Mailing address:
  • Phone: 703-927-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-308155
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000130
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: