Provider Demographics
NPI:1316941289
Name:DICRISTOFARO, SHARON (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:DICRISTOFARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WESTHALL LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7102
Mailing Address - Country:US
Mailing Address - Phone:407-200-2700
Mailing Address - Fax:
Practice Address - Street 1:11317 LAKE UNDERHILL RD STE 600
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4453
Practice Address - Country:US
Practice Address - Phone:407-641-0426
Practice Address - Fax:407-641-0427
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2025-02-13
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
FLME 128902208000000X
FLME128902208D00000X, 208000000X
WV20510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807299000Medicaid
FL018009400Medicaid