Healthcare Provider Details

I. General information

NPI: 1750696720
Provider Name (Legal Business Name): SHARON E BLOOM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 239-223-2751
  • Fax: 239-561-2933
Mailing address:
  • Phone: 239-223-2751
  • Fax: 239-561-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008831
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: