Provider Demographics
NPI:1114938362
Name:HAGEN, SHARON KAYE (PH D)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAYE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 NE 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470
Mailing Address - Country:US
Mailing Address - Phone:352-351-1007
Mailing Address - Fax:352-351-1050
Practice Address - Street 1:911 NE 2ND STREET
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470
Practice Address - Country:US
Practice Address - Phone:352-351-1007
Practice Address - Fax:352-351-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5788103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8638Medicare ID - Type Unspecified