Provider Demographics
NPI:1700875127
Name:KHAN LEPAK, SHARON (DO)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KHAN LEPAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-5665
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:3801 S KANNER HWY STE 300
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4801
Practice Address - Country:US
Practice Address - Phone:772-781-2791
Practice Address - Fax:772-223-2819
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001283800Medicaid
FLCM365Medicare PIN
FL001283800Medicaid
MI4506538Medicaid