Provider Demographics
NPI:1023043825
Name:GRUNDY, SHARON ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANN
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-1229
Mailing Address - Country:US
Mailing Address - Phone:970-728-3848
Mailing Address - Fax:970-728-6855
Practice Address - Street 1:500 WEST PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-1229
Practice Address - Country:US
Practice Address - Phone:970-728-3848
Practice Address - Fax:970-728-3404
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO 39510OtherSTATE ID
COH38933Medicare UPIN