Provider Demographics
NPI:1811049562
Name:THEROUX, SHARON M (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:M
Last Name:THEROUX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 WEST CAMINO REAL
Mailing Address - Street 2:SUITE #123
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-395-0243
Mailing Address - Fax:561-391-5054
Practice Address - Street 1:7100 WEST CAMINO REAL
Practice Address - Street 2:SUITE #123
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-395-0243
Practice Address - Fax:561-391-5054
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5497103G00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S28569Medicare UPIN
FL54076Medicare ID - Type Unspecified