Provider Demographics
NPI:1477016210
Name:VIDAL, SHARINA M (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARINA
Middle Name:M
Last Name:VIDAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5222
Mailing Address - Country:US
Mailing Address - Phone:407-767-2477
Mailing Address - Fax:407-767-1627
Practice Address - Street 1:846 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5222
Practice Address - Country:US
Practice Address - Phone:407-767-2477
Practice Address - Fax:407-767-1627
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics