Provider Demographics
NPI:1730522806
Name:SECOLA, SHARON ANN
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:SECOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 AUSTIN HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4844
Mailing Address - Country:US
Mailing Address - Phone:210-342-6488
Mailing Address - Fax:210-342-6725
Practice Address - Street 1:1122 AUSTIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4844
Practice Address - Country:US
Practice Address - Phone:210-342-6488
Practice Address - Fax:210-342-6725
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2675207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS2675OtherTEXAS MEDICAID BOARD