Provider Demographics
NPI:1104913235
Name:SHARPE, DERON (MD)
Entity type:Individual
Prefix:
First Name:DERON
Middle Name:
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0280
Mailing Address - Country:US
Mailing Address - Phone:850-932-5055
Mailing Address - Fax:850-932-1404
Practice Address - Street 1:400 GULF BREEZE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4458
Practice Address - Country:US
Practice Address - Phone:850-932-5055
Practice Address - Fax:850-932-1404
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL337442084N0402X
FLME1591442084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-54132OtherBC/BS
FL013602700Medicaid
GA003152661AMedicaid
AL165797Medicaid