Provider Demographics
NPI:1770459729
Name:SHARRON PEDIATRIC CENTER
Entity type:Organization
Organization Name:SHARRON PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BRAZIEL-MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-799-8059
Mailing Address - Street 1:5045 SOUTEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1898
Mailing Address - Country:US
Mailing Address - Phone:904-799-8059
Mailing Address - Fax:904-300-3228
Practice Address - Street 1:5045 SOUTEL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1898
Practice Address - Country:US
Practice Address - Phone:904-799-8059
Practice Address - Fax:904-300-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty