Provider Demographics
NPI:1972502326
Name:SHARNOFF, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SHARNOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COTS ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3866
Mailing Address - Country:US
Mailing Address - Phone:203-924-4747
Mailing Address - Fax:203-924-2495
Practice Address - Street 1:9 COTS ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3866
Practice Address - Country:US
Practice Address - Phone:203-924-4747
Practice Address - Fax:203-924-2495
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
030000184CT01OtherBCBS
CT41608OtherUS HEALTH CARE
5020099002OtherCIGNA
P391894OtherOXFORD
CT000960OtherPHS
CT004006565Medicaid
030000184CT01OtherBCBS
480000224Medicare PIN
CT442480073Medicare PIN