Provider Demographics
NPI:1386698850
Name:ITAYA, SHARON SATSUKI (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:SATSUKI
Last Name:ITAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 WALLER ST
Mailing Address - Street 2:ATTN: FINANCE, 5TH FLOOR
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5240
Mailing Address - Country:US
Mailing Address - Phone:572-978-9000
Mailing Address - Fax:572-978-9001
Practice Address - Street 1:2529 S 1ST ST
Practice Address - Street 2:SOUTH AUSTIN COMMUNITY HEALTH CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5466
Practice Address - Country:US
Practice Address - Phone:572-972-4722
Practice Address - Fax:572-972-4708
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF7789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132467502Medicaid
513708YLPSOtherWELLMED MEDICAL GROUP
F48331Medicare UPIN
TX132467502Medicaid