=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225559776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEATHER A SHARKEY DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 FOREST FALLS DR STOP 11
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-847-9200
-----------------------------------------------------
Fax | 207-847-9315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 FOREST FALLS DR STOP 11
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-847-9200
-----------------------------------------------------
Fax | 207-847-9315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HEATHER A SHARKEY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 207-847-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | DO2042
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------