Provider Demographics
NPI:1679878276
Name:ANTHONY, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:ANTHONY
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 1:4740 W ATLANTIC BLVD
Mailing Address - Street 2:APT 107
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6733
Mailing Address - Country:US
Mailing Address - Phone:954-588-6528
Mailing Address - Fax:
Practice Address - Street 1:12555 ORANGE DR
Practice Address - Street 2:SUITE 222
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4304
Practice Address - Country:US
Practice Address - Phone:954-862-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001363400Medicaid