Healthcare Provider Details

I. General information

NPI: 1356302392
Provider Name (Legal Business Name): SHARON PATRICIA WINN MCKIERNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/14/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 ARLINGTON BLVD
FALLS CHURCH VA
22042-2929
US

IV. Provider business mailing address

7700 ARLINGTON BLVD
FALLS CHURCH VA
22042-2929
US

V. Phone/Fax

Practice location:
  • Phone: 571-623-0618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101058020
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: