Basic Information
| Provider Information | |||||||||
| NPI: | 1639149446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | BUDNIAK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BUDNIAK | ||||||||
| OtherFirstName: | SHARON | ||||||||
| OtherMiddleName: | LEE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 930 W 21ST ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235171516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576228358 | ||||||||
| FaxNumber: | 7576229662 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 W 21ST ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235171516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576228358 | ||||||||
| FaxNumber: | 7576229662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 0101243028 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 0101243028 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1639149446 | 05 | VA | MEDICAID | 354751 | 01 | VA | ANTHEM BC/BS | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | 10033745 | 01 | VA | SENTARA/OPTIMA | OTHER | 5328668 | 01 | VA | AETNA | OTHER | 09398 | 01 | NC | NC BC/BS | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL | OTHER |