Provider Demographics
NPI:1760573422
Name:MILLER, SHARON LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:STE. 104B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3458
Mailing Address - Country:US
Mailing Address - Phone:561-368-9940
Mailing Address - Fax:561-423-2609
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:STE. 104B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-368-9940
Practice Address - Fax:561-423-2609
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5025103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59508Medicare ID - Type UnspecifiedFL MEDICARE # PSYCHOLOGIS