Provider Demographics
NPI:1023554771
Name:SHARON NATURAL MEDICAL CENTER LLC
Entity type:Organization
Organization Name:SHARON NATURAL MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:407-758-0179
Mailing Address - Street 1:1937 CORNER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-1952
Mailing Address - Country:US
Mailing Address - Phone:407-758-0179
Mailing Address - Fax:407-602-0942
Practice Address - Street 1:924 N MAGNOLIA AVE STE 332
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3852
Practice Address - Country:US
Practice Address - Phone:407-758-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107565300Medicaid