Provider Demographics
NPI:1801877279
Name:ZELLIS, SHARON L (DO)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:L
Last Name:ZELLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1260 VALLEY FORGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2691
Mailing Address - Country:US
Mailing Address - Phone:610-983-3980
Mailing Address - Fax:610-983-3406
Practice Address - Street 1:1260 VALLEY FORGE RD
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2691
Practice Address - Country:US
Practice Address - Phone:610-983-3980
Practice Address - Fax:610-983-3406
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006935L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67173Medicare UPIN
PA113168Medicare ID - Type Unspecified