MEDICARE: JEREMY T. SHARP, PH.D., LLC

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	103T00000X	Psychologist	3349	CO

General Provider Information

NPI Number	:	1104156777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY T. SHARP, PH.D., LLC

Provider Business Mailing Address
First Line	:	3500 JOHN F KENNEDY PKWY STE 200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2635
Country	:	US
Telephone Number	:	970-889-8204
Fax Number	:	888-494-3756

Provider Business Practice Location Address
First Line	:	3500 JOHN F KENNEDY PKWY STE 200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2635
Country	:	US
Telephone Number	:	970-889-8204
Fax Number	:	888-494-3756

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. JEREMY THOMAS SHARP
Credential	:	PH.D.
Telephone Number	:	970-420-7919

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	08/14/2020

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