MEDICARE: DR. SHARON ANN NICOLAZZI M.D.

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	207N00000X	Dermatology Physician	MD0026996	WA

General Provider Information

NPI Number	:	1275586307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON ANN NICOLAZZI M.D.

Provider Business Mailing Address
First Line	:	21701 76TH AVE W
Second Line	:	SUITE 100
City	:	EDMONDS
State	:	WA
Zip	:	98026-7536
Country	:	US
Telephone Number	:	206-525-1168
Fax Number	:	425-778-6159

Provider Business Practice Location Address
First Line	:	21701 76TH AVE W
Second Line	:	SUITE 100
City	:	EDMONDS
State	:	WA
Zip	:	98026-7536
Country	:	US
Telephone Number	:	206-525-1168
Fax Number	:	425-778-6159

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/07/2016

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