Provider Demographics
NPI:1760599542
Name:DEVITA, SHARON E (DN)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:E
Last Name:DEVITA
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:773-254-8977
Mailing Address - Fax:773-254-8944
Practice Address - Street 1:735 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:773-254-8977
Practice Address - Fax:773-254-8944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181-000212174400000X
IL181000212174400000X, 172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No174400000XOther Service ProvidersSpecialist