Provider Demographics
NPI:1083788285
Name:ROONEY-GANDY, SHARON ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANNE
Last Name:ROONEY-GANDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MED PARK DRIVE,
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3285
Mailing Address - Country:US
Mailing Address - Phone:574-267-8728
Mailing Address - Fax:574-269-3470
Practice Address - Street 1:42 N SAINT JOSEPH AVE STE 103
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-683-8528
Practice Address - Fax:269-683-8660
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010112582083P0011X
IN02003179A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200950390Medicaid
MIF05076Medicare UPIN
IN262490VMedicare PIN
IN200950390Medicaid