Provider Demographics
NPI:1578656468
Name:ANDREOLI, SHARON P (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:P
Last Name:ANDREOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:P
Other - Last Name:ANDREOLI-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RR 230
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-2563
Practice Address - Fax:317-278-3599
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010281032080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64879182Medicaid
350593390-042OtherTRICARE-DEAC-350593390
IN100236800Medicaid
000000375508OtherANTHEM-DEAC-350593390
182780ZMedicare ID - Type UnspecifiedDEACONESS-350593390
KY64879182Medicaid
350593390-042OtherTRICARE-DEAC-350593390