Provider Demographics
NPI:1902423031
Name:SHARP, KIM DENISE (BA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:DENISE
Last Name:SHARP
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 ANDRUS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5456
Mailing Address - Country:US
Mailing Address - Phone:321-419-7735
Mailing Address - Fax:
Practice Address - Street 1:5222 ANDRUS AVE STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5456
Practice Address - Country:US
Practice Address - Phone:321-419-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker