Provider Demographics
NPI:1952441560
Name:THETFORD, SHARON RIFKIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:RIFKIN
Last Name:THETFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CROWN OAK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6188
Mailing Address - Country:US
Mailing Address - Phone:407-339-1159
Mailing Address - Fax:407-339-2405
Practice Address - Street 1:620 CROWN OAK CENTRE DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6188
Practice Address - Country:US
Practice Address - Phone:407-339-1159
Practice Address - Fax:407-339-2405
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical