Provider Demographics
NPI:1558311282
Name:DILLON, SHARON ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANGELA
Last Name:DILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3150 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2322
Mailing Address - Country:US
Mailing Address - Phone:321-242-3227
Mailing Address - Fax:321-242-3227
Practice Address - Street 1:3150 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2322
Practice Address - Country:US
Practice Address - Phone:321-242-3227
Practice Address - Fax:321-242-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 63734208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4645402OtherAETNA PPO/POS
FL204827OtherWELLCARE
FL238868OtherAMERIGROUP
FL0919594OtherAETNA HMO
FL25897OtherBCBS
FL374715800Medicaid
FLF90362Medicare UPIN