Provider Demographics
NPI:1316545585
Name:LACCONE, SHARA LISETTE
Entity Type:Individual
Prefix:
First Name:SHARA
Middle Name:LISETTE
Last Name:LACCONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 BEACON RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9820
Mailing Address - Country:US
Mailing Address - Phone:912-882-9293
Mailing Address - Fax:
Practice Address - Street 1:117 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8949
Practice Address - Country:US
Practice Address - Phone:912-882-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50134472084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry