Provider Demographics
NPI:1396758637
Name:JOHNSTON, SHARON LORETTA (DO)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:LORETTA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:599 9TH STREET NORTH
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-262-7007
Mailing Address - Fax:239-262-3733
Practice Address - Street 1:599 9TH STREET NORTH
Practice Address - Street 2:SUITE 307
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-262-7007
Practice Address - Fax:239-262-3733
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL05-69132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
57496AMedicare ID - Type Unspecified
G56899Medicare UPIN