Provider Demographics
NPI:1326280769
Name:MONTANDON, SHARI VANDYKE (DO)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:VANDYKE
Last Name:MONTANDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:MARIE
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:550 S JACKSON ST
Mailing Address - Street 2:ACB 3RD FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:714 W APPLEWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-9330
Practice Address - Country:US
Practice Address - Phone:208-665-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO0945207RA0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology