Healthcare Provider Details

I. General information

NPI: 1700875127
Provider Name (Legal Business Name): SHARON KHAN LEPAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHARON KHAN

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S KANNER HWY STE 300
STUART FL
34994-4801
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-2791
  • Fax: 772-223-2819
Mailing address:
  • Phone: 772-223-5665
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: