MEDICARE: MISS SHARON WILLIAMS-BEASLEY

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1083973093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHARON WILLIAMS-BEASLEY

Provider Business Mailing Address
First Line	:	4420 ACROPOLIS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3443
Country	:	US
Telephone Number	:	702-578-3769
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 ACROPOLIS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3449
Country	:	US
Telephone Number	:	702-578-3769
Fax Number	:

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

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	11/20/2012

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