Provider Demographics
NPI:1548087265
Name:VAZQUEZ SILVA, SHARON MARIE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:VAZQUEZ SILVA
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 1:909 AVE TITO CASTRO
Mailing Address - Street 2:STE 712 TORRE MEDICA SAN LUCAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4722
Mailing Address - Country:US
Mailing Address - Phone:787-813-0550
Mailing Address - Fax:
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:STE 712 TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4722
Practice Address - Country:US
Practice Address - Phone:787-813-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical