Provider Demographics
NPI:1164646014
Name:HENRY, SHARON MICHELE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MICHELE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JANWALL ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1937
Mailing Address - Country:US
Mailing Address - Phone:410-280-5214
Mailing Address - Fax:
Practice Address - Street 1:DILORENZO TRICARE HEALTH CLINIC
Practice Address - Street 2:5801 ARMY PENTAGON
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-0001
Practice Address - Country:US
Practice Address - Phone:703-639-7605
Practice Address - Fax:910-323-1913
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001973363A00000X
NC139762363A00000X
DCPA030316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant