Healthcare Provider Details

I. General information

NPI: 1962594150
Provider Name (Legal Business Name): SHARON ROSEANN MAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 LAKE AVE
FORT WAYNE IN
46805-5100
US

IV. Provider business mailing address

2121 LAKE AVE
FORT WAYNE IN
46805-5100
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-5431
  • Fax: 260-460-1425
Mailing address:
  • Phone: 260-426-5431
  • Fax: 260-460-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number010413A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number010413A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: