Individual
SHARON SCHROEDER WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7409 US 42, FLORENCE, KY 41042-1905
(859) 525-8181
(859) 525-8289
Mailing address
7409 US 42, FLORENCE, KY 41042-1905
(859) 525-8181
(859) 525-8289
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35 075729
OH
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
30584
KY
2084P0804X
Child & Adolescent Psychiatry Physician
30584
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184607
MEDICARE GROUP NUMBER
KY
01
—
311542435
FEDERAL TAX ID
—
05
—
65932758
—
KY
Enumeration date
04/14/2006
Last updated
11/03/2014
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