Provider Demographics
NPI:1104842541
Name:BASHAM, SHARON L (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BASHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:BROADBENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3905 STATE ST STE 7-132
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3138
Mailing Address - Country:US
Mailing Address - Phone:805-689-5718
Mailing Address - Fax:805-563-7671
Practice Address - Street 1:2415 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3819
Practice Address - Country:US
Practice Address - Phone:805-689-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA600912081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA250013397OtherRR MEDICARE
CAGR0040970Medicaid
CA952817515OtherEIN
CA952817515OtherEIN
CAWA60091AMedicare PIN
CAWA60091CMedicare PIN
CAW9293Medicare PIN
CA250013397OtherRR MEDICARE
CAG67070Medicare UPIN
CAW9293EMedicare PIN