Provider Demographics
NPI:1427070671
Name:PEREIRA-MATSUMOTO, SHARON (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:PEREIRA-MATSUMOTO
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:310 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1800
Practice Address - Country:US
Practice Address - Phone:530-224-2223
Practice Address - Fax:530-244-4799
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG742172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090640Medicaid
CAGR0090641Medicaid
CAGR0090640Medicaid
CAGR0090641Medicaid
CAZZZ23187ZMedicare PIN