MEDICARE: SHARI ELIZABETH KONTRATH BOCPD, CPED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224L00000X	Pedorthist	C50548	FL

General Provider Information

NPI Number	:	1255869442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI ELIZABETH KONTRATH BOCPD, CPED

Provider Business Mailing Address
First Line	:	6780 SAMBA ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-3069
Country	:	US
Telephone Number	:	772-801-9475
Fax Number	:	888-789-0771

Provider Business Practice Location Address
First Line	:	6780 SAMBA ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-3069
Country	:	US
Telephone Number	:	772-801-9475
Fax Number	:	888-789-0771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	07/21/2022

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