Provider Demographics
NPI:1053087999
Name:KIDD, SHAROWN
Entity Type:Individual
Prefix:
First Name:SHAROWN
Middle Name:
Last Name:KIDD
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 1:512 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:WV
Mailing Address - Zip Code:45744
Mailing Address - Country:US
Mailing Address - Phone:216-774-4611
Mailing Address - Fax:
Practice Address - Street 1:512 SIXTH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:WV
Practice Address - Zip Code:45744
Practice Address - Country:US
Practice Address - Phone:216-774-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker