Provider Demographics
NPI:1386613164
Name:CROOKSHANKS, SHARON ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANNE
Last Name:CROOKSHANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 STARKEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0622
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-343-7693
Practice Address - Street 1:4461 STARKEY RD STE 201
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-345-4946
Practice Address - Fax:540-343-7693
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical