Provider Demographics
NPI:1174563340
Name:GILLESPIE, SHARON ELLEN IV (CCC-A)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELLEN
Last Name:GILLESPIE
Suffix:IV
Gender:F
Credentials:CCC-A
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Mailing Address - Street 1:CREDENTIALS OFFICE,KLELLER ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:900 WASHINGTON RD
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1197
Mailing Address - Country:US
Mailing Address - Phone:845-938-8281
Mailing Address - Fax:845-938-6671
Practice Address - Street 1:900 WASHINGTON RD
Practice Address - Street 2:CREDENTIALS OFFICE, KELLER ARMY COMMUNITY HOSPITAL
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1109
Practice Address - Country:US
Practice Address - Phone:845-938-8281
Practice Address - Fax:845-938-6671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY001648-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN