Provider Demographics
NPI:1083968358
Name:SHARPE, SHAUNA ALI (DPT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:ALI
Last Name:SHARPE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16729 TALL GRASS LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6621
Mailing Address - Country:US
Mailing Address - Phone:561-891-6415
Mailing Address - Fax:
Practice Address - Street 1:16729 TALL GRASS LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6621
Practice Address - Country:US
Practice Address - Phone:561-891-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist