Provider Demographics
NPI:1457630220
Name:SHARPE, CARISSA LYN (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:LYN
Last Name:SHARPE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7551 FREDLE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9406
Mailing Address - Country:US
Mailing Address - Phone:440-350-9595
Mailing Address - Fax:440-357-1905
Practice Address - Street 1:7551 FREDLE DR
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9406
Practice Address - Country:US
Practice Address - Phone:440-350-9595
Practice Address - Fax:440-357-1905
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003573213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist