Provider Demographics
NPI:1942460647
Name:PASS, SHARON KRISTEN (LMT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KRISTEN
Last Name:PASS
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 1:11335 NW 43RD PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7220
Mailing Address - Country:US
Mailing Address - Phone:954-592-6537
Mailing Address - Fax:
Practice Address - Street 1:11335 NW 43RD PL
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-7220
Practice Address - Country:US
Practice Address - Phone:954-592-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-46347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist