MEDICARE: ERIN NOEL SHARKEY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-21-49656

General Provider Information

NPI Number	:	1023638301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN NOEL SHARKEY BCBA

Provider Business Mailing Address
First Line	:	8428 BIG HORN WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5730
Country	:	US
Telephone Number	:	609-713-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	8428 BIG HORN WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5730
Country	:	US
Telephone Number	:	609-713-9764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	02/06/2024

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