Provider Demographics
NPI:1124069166
Name:CASSIDY, SHARON SUE (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SUE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 WALTER REED BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3701
Mailing Address - Country:US
Mailing Address - Phone:972-494-1446
Mailing Address - Fax:972-276-5476
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3701
Practice Address - Country:US
Practice Address - Phone:972-494-1446
Practice Address - Fax:972-276-5476
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD9387207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M2953OtherBCBS
TX114016206Medicaid
TX114016204Medicaid
TX8D3786Medicare PIN
C14285Medicare UPIN
TX114016206Medicaid
TXP00205479Medicare PIN