Provider Demographics
NPI:1609501071
Name:SHARP, THOMAS DYLAN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DYLAN
Last Name:SHARP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12719 SUQUALENA RD
Mailing Address - Street 2:
Mailing Address - City:CHUNKY
Mailing Address - State:MS
Mailing Address - Zip Code:39323-9635
Mailing Address - Country:US
Mailing Address - Phone:601-227-2236
Mailing Address - Fax:
Practice Address - Street 1:12719 SUQUALENA RD
Practice Address - Street 2:
Practice Address - City:CHUNKY
Practice Address - State:MS
Practice Address - Zip Code:39323-9635
Practice Address - Country:US
Practice Address - Phone:601-227-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program