Provider Demographics
NPI:1265473037
Name:SANTOS, SHARON RH (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RH
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ROSE
Other - Last Name:HORMACHUELOS-SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1706 S MERIDIAN
Mailing Address - Street 2:STE 120
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:253-446-3239
Practice Address - Street 1:10004 204TH AVE E
Practice Address - Street 2:SUITE 1300
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6535
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:253-826-1264
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8286262Medicaid
WAI21192Medicare UPIN
WA8809161Medicare ID - Type UnspecifiedNORIDIAN