Healthcare Provider Details

I. General information

NPI: 1396758637
Provider Name (Legal Business Name): SHARON LORETTA JOHNSTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 9TH STREET NORTH SUITE 307
NAPLES FL
34102
US

IV. Provider business mailing address

599 9TH STREET NORTH SUITE 307
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-7007
  • Fax: 239-262-3733
Mailing address:
  • Phone: 239-262-7007
  • Fax: 239-262-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number05-6913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: