Provider Demographics
NPI:1891791380
Name:GOLDISH, SHARON NOBLE (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:NOBLE
Last Name:GOLDISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 N CLYDE MORRIS BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2724
Mailing Address - Country:US
Mailing Address - Phone:386-425-3165
Mailing Address - Fax:386-254-4285
Practice Address - Street 1:201 N CLYDE MORRIS BLVD
Practice Address - Street 2:STE 205
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2724
Practice Address - Country:US
Practice Address - Phone:386-425-3165
Practice Address - Fax:386-254-4285
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101229208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086177Medicaid
ILG19841Medicare UPIN
IL516420Medicare ID - Type Unspecified