Healthcare Provider Details

I. General information

NPI: 1083702849
Provider Name (Legal Business Name): SHARON BROM CHANEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 STONEGATE TRL 100
VESTAVIA HLS AL
35242-2267
US

IV. Provider business mailing address

PO BOX 430125
BIRMINGHAM AL
35243-1125
US

V. Phone/Fax

Practice location:
  • Phone: 205-595-0395
  • Fax: 205-599-9024
Mailing address:
  • Phone: 205-595-0395
  • Fax: 205-599-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00023549
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: