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Individual

SHARON LYNNE JIVIDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS CCCA

Contact information

Practice address
508 NEW HOPE ROAD, SUITE #19, PRINCETON, WV 24740-2272
(304) 487-2487
(304) 431-3367
Mailing address
508 NEW HOPE ROAD, SUITE #19, PRINCETON, WV 24740-2272
(304) 487-2487
(304) 431-3367

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
2101000721
VA
231H00000X
Audiologist
2201000469
VA
231H00000X
Audiologist
Primary
A0203
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0602472
PALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE
01
0602473
PALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE
05
3810001841
WV
Enumeration date
03/01/2006
Last updated
06/05/2013
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