Active NPI
Sharadyn Nicole Ille, DMD
- Periodontics
- Morgantown, WV
National Provider Identifier
1760368732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 4787
- Practice address
- 451 Suncrest Town Centre Dr
Morgantown, WV 26505-1814 - Phone
- (304) 293-5831
- NPI assigned
- Aug 14, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 4787 | WV | Primary |
Addresses
Primary practice location
451 Suncrest Town Centre Dr
Morgantown, WV 26505-1814
Mailing address
8033 Evening Whisper Way
Cincinnati, OH 45244-4901
Phone (513) 568-6152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4787 | WV | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755129600000",
"number": "1760368732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8033 EVENING WHISPER WAY",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452444901",
"telephone_number": "513-568-6152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 SUNCREST TOWN CENTRE DR",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265051814",
"telephone_number": "304-293-5831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLE",
"first_name": "SHARADYN",
"middle_name": "NICOLE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-14",
"last_updated": "2025-08-14",
"certification_date": "2025-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WV",
"license": "4787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morgantown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.