Provider Demographics
NPI:1407143498
Name:SHARON M PARKINSON PSYD PL
Entity Type:Organization
Organization Name:SHARON M PARKINSON PSYD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:239-370-1188
Mailing Address - Street 1:24850 BURNT PINE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-0905
Mailing Address - Country:US
Mailing Address - Phone:239-949-1188
Mailing Address - Fax:239-949-1166
Practice Address - Street 1:24850 BURNT PINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-0905
Practice Address - Country:US
Practice Address - Phone:239-370-1188
Practice Address - Fax:239-692-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7793103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty