Provider Demographics
NPI:1861632366
Name:HIERONIMUS, SHARON KAY (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:HIERONIMUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 SHARP CT
Mailing Address - Street 2:200
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2418
Mailing Address - Country:US
Mailing Address - Phone:407-314-5098
Mailing Address - Fax:
Practice Address - Street 1:1750 W BROADWAY ST
Practice Address - Street 2:108
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9618
Practice Address - Country:US
Practice Address - Phone:407-977-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA27829OtherMASSAGE THERAPY LIS NUMBER