Provider Demographics
NPI:1104932433
Name:CRENSHAW, SHARON G (PHYSICIAN EXTENDER)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:G
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:PHYSICIAN EXTENDER
Other - Prefix:
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Mailing Address - Street 1:312 MERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3332
Mailing Address - Country:US
Mailing Address - Phone:919-832-9129
Mailing Address - Fax:
Practice Address - Street 1:301 N HERMAN STREET BOX CC
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1056
Practice Address - Country:US
Practice Address - Phone:919-731-1250
Practice Address - Fax:919-731-1232
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant