Provider Demographics
NPI:1851581474
Name:FAIR, SHARON
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:FAIR KURTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1542 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4586
Mailing Address - Country:US
Mailing Address - Phone:904-540-5120
Mailing Address - Fax:904-284-1624
Practice Address - Street 1:1542 KINGSLEY AVE
Practice Address - Street 2:SUITE 137
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4586
Practice Address - Country:US
Practice Address - Phone:904-540-5120
Practice Address - Fax:904-284-1624
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 12315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist