Provider Demographics
NPI:1053511600
Name:BUCK, SHARON ELIZABETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:BUCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-5018
Mailing Address - Country:US
Mailing Address - Phone:386-328-3743
Mailing Address - Fax:386-328-3038
Practice Address - Street 1:610 S 14TH ST
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-5018
Practice Address - Country:US
Practice Address - Phone:386-328-3743
Practice Address - Fax:386-328-3038
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist