MEDICARE: MS. SHARON V. BRODIE A.T.,C.

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	390200000X	Student in an Organized Health Care Education/Training Program	000471	NY

General Provider Information

NPI Number	:	1659345593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON V. BRODIE A.T.,C.

Provider Business Mailing Address
First Line	:	2706 FOXWOOD DR S
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-7024
Country	:	US
Telephone Number	:	518-280-6827
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 EXECUTIVE PARK DR
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-3718
Country	:	US
Telephone Number	:	518-489-2449
Fax Number	:

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/08/2007

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