Healthcare Provider Details

I. General information

NPI: 1174594295
Provider Name (Legal Business Name): SHARON L SHELTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON S. FAWAZ DO

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2984 S RIDGEWOOD AVE STE A
EDGEWATER FL
32141-7527
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 2
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 386-428-4640
  • Fax:
Mailing address:
  • Phone: 904-293-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: