MEDICARE: SHARA MARSHALL MS, MSW, LCSWA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1386260255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARA MARSHALL MS, MSW, LCSWA

Provider Business Mailing Address
First Line	:	311 MERRION PARK LN
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6316
Country	:	US
Telephone Number	:	919-937-3324
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 S MIAMI BLVD STE 108
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-4928
Country	:	US
Telephone Number	:	919-572-8833
Fax Number	:

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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