Provider Demographics
NPI:1588676175
Name:LOHSE, SHAREEN (PA-C)
Entity type:Individual
Prefix:
First Name:SHAREEN
Middle Name:
Last Name:LOHSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAREEN
Other - Middle Name:
Other - Last Name:DEBLASIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:439 S PLEASANT GROVE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3493
Mailing Address - Country:US
Mailing Address - Phone:800-640-3451
Mailing Address - Fax:
Practice Address - Street 1:8320 W SUNRISE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5432
Practice Address - Country:US
Practice Address - Phone:800-640-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP33822Medicare UPIN
FLE56822Medicare ID - Type Unspecified