=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083150783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON ANN SUTHERLAND PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2017
-----------------------------------------------------
Last Update Date | 01/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3512 QUENTIN RD
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-4244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-860-0149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 LYNWOOD RD
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-5212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-819-8643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 021835-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------