Healthcare Provider Details

I. General information

NPI: 1023144243
Provider Name (Legal Business Name): SHARON ROSENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E REDSTONE AVE
CRESTVIEW FL
32539-5348
US

IV. Provider business mailing address

160 E REDSTONE AVE
CRESTVIEW FL
32539-5348
US

V. Phone/Fax

Practice location:
  • Phone: 850-689-0555
  • Fax: 850-689-3531
Mailing address:
  • Phone: 850-689-0555
  • Fax: 850-689-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME79435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: