Provider Demographics
NPI:1235497280
Name:ROSS, SHARON E (OWNER)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:E
Last Name:ROSS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18949 MARSH LN
Mailing Address - Street 2:STE 1110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-2100
Mailing Address - Country:US
Mailing Address - Phone:940-783-5475
Mailing Address - Fax:
Practice Address - Street 1:18949 MARSH LN
Practice Address - Street 2:STE 1110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-2100
Practice Address - Country:US
Practice Address - Phone:940-783-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45-5149906172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver