Healthcare Provider Details

I. General information

NPI: 1669902847
Provider Name (Legal Business Name): SHARON DESIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WEST CYPRESS CREEK ROAD, EXECUTIVE COURT, B-106
FORT LAUDERDALE FL
33309
US

IV. Provider business mailing address

2700 WEST CYPRESS CREEK ROAD EXECUTIVE COURT, B-106
FORT LAUDERDALE FL
33309
US

V. Phone/Fax

Practice location:
  • Phone: 954-514-7659
  • Fax:
Mailing address:
  • Phone: 954-514-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: