Provider Demographics
NPI:1841452836
Name:MCQUILLAN, SHARON P (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:P
Last Name:MCQUILLAN
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 1:3112 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4327
Mailing Address - Country:US
Mailing Address - Phone:954-858-5888
Mailing Address - Fax:954-900-9944
Practice Address - Street 1:3112 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4327
Practice Address - Country:US
Practice Address - Phone:954-858-5888
Practice Address - Fax:954-900-8844
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84724207Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine