Healthcare Provider Details

I. General information

NPI: 1639426430
Provider Name (Legal Business Name): MS. SHARON R SANQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 DIXON BLVD
COCOA FL
32922-6411
US

IV. Provider business mailing address

1407 DIXON BLVD
COCOA FL
32922-6411
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-0800
  • Fax: 321-394-0385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: