Healthcare Provider Details

I. General information

NPI: 1346313897
Provider Name (Legal Business Name): SHARON BETH STANFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON BETH LOUTENSOCK M.D.

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 MORGAN ST
CINCINNATI OH
45206-2348
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-873-1567
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35.082821
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35082821
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: