Provider Demographics
NPI:1184692444
Name:KELLY, SHARON SUE (DO)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SUE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-284-3400
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:6116 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5752
Practice Address - Country:US
Practice Address - Phone:303-512-0888
Practice Address - Fax:303-512-2288
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31623207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01316231Medicaid
NM36586269Medicaid
AZ843385Medicaid
UTZ6603Medicaid
UTZ6603Medicaid
COP00299140Medicare PIN
NM36586269Medicaid