Healthcare Provider Details

I. General information

NPI: 1265469852
Provider Name (Legal Business Name): SHARON LILLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 HIGHWAY 190 SUITE C
COVINGTON LA
70433-4954
US

IV. Provider business mailing address

7020 HIGHWAY 190 SUITE C
COVINGTON LA
70433-4954
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-7337
  • Fax: 985-871-7600
Mailing address:
  • Phone: 985-871-7337
  • Fax: 985-871-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number020574
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: