Provider Demographics
NPI:1679666804
Name:WASSERSTROM, SHARON M (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:WASSERSTROM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 QUADRANGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1492
Mailing Address - Country:US
Mailing Address - Phone:407-266-3627
Mailing Address - Fax:407-882-4799
Practice Address - Street 1:9975 TAVISTOCK LAKES BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7664
Practice Address - Country:US
Practice Address - Phone:407-266-3627
Practice Address - Fax:407-882-4799
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME138076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101210100Medicaid