Healthcare Provider Details

I. General information

NPI: 1356305478
Provider Name (Legal Business Name): SHARON SCHROEDER WYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON LYNN SCHROEDER M.D.

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 US 42
FLORENCE KY
41042-1905
US

IV. Provider business mailing address

7409 US 42
FLORENCE KY
41042-1905
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-8181
  • Fax: 859-525-8289
Mailing address:
  • Phone: 859-525-8181
  • Fax: 859-525-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number30584
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35 075729
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30584
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: