Provider Demographics
NPI:1912991548
Name:NICHOLS, SHARON (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2436
Mailing Address - Country:US
Mailing Address - Phone:407-767-8554
Mailing Address - Fax:407-767-9121
Practice Address - Street 1:450 W CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2436
Practice Address - Country:US
Practice Address - Phone:407-767-8554
Practice Address - Fax:407-767-9121
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12428207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57431VMedicare UPIN
G38581Medicare UPIN
MT000099286OtherBLUE CROSS OF MONTANA