Provider Demographics
NPI:1831248335
Name:HENDERSON, SHARON
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 OLD TOM WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 HILLSBOROUGH ST
Practice Address - Street 2:CARROLL HEALTH CENTER
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5237
Practice Address - Country:US
Practice Address - Phone:919-760-8139
Practice Address - Fax:919-760-8534
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant