Basic Information
Provider Information
NPI: 1154455327
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COHEN
FirstName: SHARON
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17940 N MILITARY TRAIL
Address2: UNIT 300
City: BOCA RATON
State: FL
PostalCode: 33498
CountryCode: US
TelephoneNumber: 5613671623
FaxNumber:  
Practice Location
Address1: 17940 N MILITARY TRAIL
Address2: UNIT 300
City: BOCA RATON
State: FL
PostalCode: 33498
CountryCode: US
TelephoneNumber: 5613671623
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/16/2007
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAY1397FLY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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