Provider Demographics
NPI:1164646485
Name:SU, SHARON W (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:W
Last Name:SU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:501 N GRAHAM ST STE 355
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-2005
Mailing Address - Country:US
Mailing Address - Phone:503-413-3926
Mailing Address - Fax:503-413-3927
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 315
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-413-3090
Practice Address - Fax:503-413-3948
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD127602080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91776OtherMEDICAL LICENSE
RIMD12760OtherLICENSE
ORMD157897OtherMEDICAL LICENSE