Basic Information
| Provider Information | |||||||||
| NPI: | 1083704241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISTFAN | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | LONDEREE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 PINNACLE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253111315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043434398 | ||||||||
| FaxNumber: | 3043882537 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043882525 | ||||||||
| FaxNumber: | 3043882537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 18526 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0110789000 | 05 | WV | MEDICAID |