Provider Demographics
NPI:1689730087
Name:CANNON, SHARON S (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:S
Last Name:CANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:A
Other - Last Name:SALKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 313
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6216
Mailing Address - Country:US
Mailing Address - Phone:410-988-2860
Mailing Address - Fax:410-988-2024
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE 313
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6216
Practice Address - Country:US
Practice Address - Phone:410-988-2860
Practice Address - Fax:410-988-2024
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE318103T00000X
MD04654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3144OtherMIDLANDS CHOICE
6135835OtherUNITED BEHAVIORAL HEALTH
NE8130OtherBCBS
271197CAMedicare ID - Type Unspecified