Provider Demographics
NPI:1679641690
Name:WINNER, SHARON RENEE (PSYD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEE
Last Name:WINNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 COLLEGE DR
Mailing Address - Street 2:SUITE 100-102
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8530
Mailing Address - Country:US
Mailing Address - Phone:904-644-8669
Mailing Address - Fax:904-298-1973
Practice Address - Street 1:430 COLLEGE DR
Practice Address - Street 2:SUITE 100-102
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8530
Practice Address - Country:US
Practice Address - Phone:904-644-8669
Practice Address - Fax:904-298-1973
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8075103TC0700X
103TC2200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling