Provider Demographics
NPI:1093956039
Name:WITT, SHARON LEE L (DO)
Entity Type:Individual
Prefix:
First Name:SHARON LEE
Middle Name:L
Last Name:WITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHARON LEE
Other - Middle Name:LEE
Other - Last Name:LONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:24600 S TAMIAMI TRL STE 500
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7025
Practice Address - Country:US
Practice Address - Phone:239-948-3761
Practice Address - Fax:239-948-3762
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12648207Q00000X
MI5101020198207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14Y3QOtherFLORIDA BLUE
FL015961500Medicaid
FL14Y3QOtherFLORIDA BLUE