MEDICARE: MRS. VICTORIA SHARP

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	225100000X	Physical Therapist	PT15239	FL
2	171W00000X	Contractor	032969	NY

General Provider Information

NPI Number	:	1942409149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA SHARP

Provider Business Mailing Address
First Line	:	3366 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2451
Country	:	US
Telephone Number	:	786-547-4222
Fax Number	:	718-653-4636

Provider Business Practice Location Address
First Line	:	3366 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-2451
Country	:	US
Telephone Number	:	786-547-4222
Fax Number	:	718-653-4636

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	10/13/2010

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