MEDICARE: MRS. WINSOME IVERENE SHARPE BA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1922295708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WINSOME IVERENE SHARPE BA

Provider Business Mailing Address
First Line	:	1495 N HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6572
Country	:	US
Telephone Number	:	321-259-8928
Fax Number	:	321-259-6060

Provider Business Practice Location Address
First Line	:	1495 N HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6572
Country	:	US
Telephone Number	:	321-259-8928
Fax Number	:	321-259-6060

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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