Provider Demographics
NPI:1366800641
Name:BENTON, SHARON LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:BENTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:STUMPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10285 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2399
Mailing Address - Country:US
Mailing Address - Phone:303-463-2636
Mailing Address - Fax:303-463-2650
Practice Address - Street 1:10285 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2301
Practice Address - Country:US
Practice Address - Phone:303-463-2636
Practice Address - Fax:303-463-2650
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant