Provider Demographics
NPI:1023441318
Name:AVERY, SHARONDA L
Entity type:Individual
Prefix:DR
First Name:SHARONDA
Middle Name:L
Last Name:AVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CHOPTANK RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6442
Mailing Address - Country:US
Mailing Address - Phone:540-602-8092
Mailing Address - Fax:
Practice Address - Street 1:302 TORBERT LOOP
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8452
Practice Address - Country:US
Practice Address - Phone:540-602-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral