Provider Demographics
NPI:1972541712
Name:SHARP SCHINSKY, LYDIA E (MD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:E
Last Name:SHARP SCHINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYDIA
Other - Middle Name:E
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1450 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-1327
Mailing Address - Country:US
Mailing Address - Phone:314-482-4703
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336076761207P00000X
IL036115454207P00000X
MO2004004907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I31819Medicare UPIN
MO000093140Medicare ID - Type UnspecifiedMEDICARE
ILR00152Medicare PIN
R00152Medicare PIN