Provider Demographics
NPI:1982006516
Name:CHEN, SHARON SHOU YUN (DDS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SHOU YUN
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PARTIN DR N
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2054
Mailing Address - Country:US
Mailing Address - Phone:850-678-7114
Mailing Address - Fax:850-678-2891
Practice Address - Street 1:136 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2054
Practice Address - Country:US
Practice Address - Phone:850-678-7114
Practice Address - Fax:850-678-2891
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist