Healthcare Provider Details

I. General information

NPI: 1730432766
Provider Name (Legal Business Name): SHARON ANNE BAILEY D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 N CENTRAL EXPY STE 126
DALLAS TX
75243-6605
US

IV. Provider business mailing address

11520 N CENTRAL EXPY STE 126
DALLAS TX
75243-6605
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-4844
  • Fax: 214-341-9997
Mailing address:
  • Phone: 214-396-4844
  • Fax: 214-341-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberG0654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: