Provider Demographics
NPI:1063032274
Name:DALTON, SHARON LYNN (MED)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:DALTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 S STATE ROAD 335
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IN
Mailing Address - Zip Code:47165
Mailing Address - Country:US
Mailing Address - Phone:502-727-6867
Mailing Address - Fax:
Practice Address - Street 1:9957 S STATE ROAD 335
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IN
Practice Address - Zip Code:47165
Practice Address - Country:US
Practice Address - Phone:502-727-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist