Provider Demographics
NPI:1144379199
Name:SOOTIN, SHARON ANN (AP,LMT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:SOOTIN
Suffix:
Gender:F
Credentials:AP,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 ATLANTIC SHORES BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2533
Mailing Address - Country:US
Mailing Address - Phone:954-458-4747
Mailing Address - Fax:
Practice Address - Street 1:616 ATLANTIC SHORES BLVD STE B
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2533
Practice Address - Country:US
Practice Address - Phone:954-458-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP957171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist