Provider Demographics
NPI:1093367104
Name:DHOM, SHARLINA D (PA)
Entity Type:Individual
Prefix:
First Name:SHARLINA
Middle Name:D
Last Name:DHOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHARLINA
Other - Middle Name:
Other - Last Name:HERBOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3610
Practice Address - Fax:217-326-2704
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant