MEDICARE: SHARON JACKSON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1285400168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON JACKSON

Provider Business Mailing Address
First Line	:	2106 COMMODORE CT
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-1011
Country	:	US
Telephone Number	:	202-830-8984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 FRANKLIN ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-4213
Country	:	US
Telephone Number	:	202-830-8984
Fax Number	:

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

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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Directions to “ SHARON JACKSON ” Practice Location

Language	Start Address	Practice Location

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