Healthcare Provider Details

I. General information

NPI: 1548400880
Provider Name (Legal Business Name): SHARON HALTER CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 LINCOLN PARK BLVD SUITE 322
KETTERING OH
45429-3474
US

IV. Provider business mailing address

580 LINCOLN PARK BLVD SUITE 322
KETTERING OH
45429-3474
US

V. Phone/Fax

Practice location:
  • Phone: 937-297-6800
  • Fax: 937-297-6810
Mailing address:
  • Phone: 937-297-6800
  • Fax: 937-297-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: