Provider Demographics
NPI:1477887784
Name:SHARE, DAWN LAVELLE (AP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LAVELLE
Last Name:SHARE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4208
Mailing Address - Country:US
Mailing Address - Phone:386-290-9493
Mailing Address - Fax:
Practice Address - Street 1:1400 HAND AVE STE N
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8196
Practice Address - Country:US
Practice Address - Phone:386-290-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27-5007598OtherIRS
FL27-0959639OtherIRS