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General NPI Number Information
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NPI Number | 1891824009
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Entity Type | Individual
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Provider Name | SHARON LISA DOHERTY ATC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 492 N FRANKLIN TPKE
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City | RAMSEY
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State | NJ
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Zip | 07446-1120
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Country | US
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Telephone | 201-327-4704
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Fax |
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Provider Business Mailing Address
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Address Line | 285 WATER FOREST DR
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City | DINGMANS FERRY
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State | PA
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Zip | 18328-3439
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Country | US
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Telephone | 570-828-8256
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Fax | 570-828-0836
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00102300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT003343
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License Number State | PA
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