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General NPI Number Information
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NPI Number | 1063725273
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Entity Type | Individual
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Provider Name | SHASTINE M SHARP M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 825 BARRET AVE
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City | LOUISVILLE
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State | KY
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Zip | 40204-1743
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Country | US
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Telephone | 931-245-8600
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Fax | 931-245-8660
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 50146
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 47825
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MT197438
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License Number State | PA
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