1073740494 NPI number — ANNE MARY SHARKEY DPM

Table of content: ANNE MARY SHARKEY DPM (NPI 1073740494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073740494 NPI number — ANNE MARY SHARKEY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARKEY
Provider First Name:
ANNE
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BREUER
Provider Other First Name:
ANNE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073740494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 COTTONWOOD CREEK TRL STE B2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-7862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-593-2949
Provider Business Mailing Address Fax Number:
512-528-8506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 COTTONWOOD CREEK TRL BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-7861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-593-2949
Provider Business Practice Location Address Fax Number:
512-528-8506
Provider Enumeration Date:
06/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  07001139A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 2230 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1073740494 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".