MEDICARE: MS. SHARON THERESA ALLEN LPN

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	164W00000X	Licensed Practical Nurse	100305-1	NY

General Provider Information

NPI Number	:	1093971392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON THERESA ALLEN LPN

Provider Business Mailing Address
First Line	:	56 SPRING VALLEY ST
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-3319
Country	:	US
Telephone Number	:	845-831-9013
Fax Number	:	845-473-6692

Provider Business Practice Location Address
First Line	:	56 SPRING VALLEY ST
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-3319
Country	:	US
Telephone Number	:	845-831-9013
Fax Number	:	845-473-6692

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

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	08/06/2008

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