Healthcare Provider Details

I. General information

NPI: 1316941289
Provider Name (Legal Business Name): SHARON DICRISTOFARO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/13/2025
Certification Date: 01/28/2025
Deactivation Date: 03/15/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

11317 LAKE UNDERHILL RD STE 600
ORLANDO FL
32825-4453
US

IV. Provider business mailing address

2600 WESTHALL LN
MAITLAND FL
32751-7102
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-0426
  • Fax: 407-641-0427
Mailing address:
  • Phone: 407-200-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 128902
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME128902
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20510
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: