Provider Demographics
NPI:1144213091
Name:CLAY MATEMAVI, SHARON DENISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DENISE
Last Name:CLAY MATEMAVI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DENISE
Other - Last Name:CLAY-KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIIONER
Mailing Address - Street 1:34875 POURROY RD APT 1408
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8184
Mailing Address - Country:US
Mailing Address - Phone:281-795-3945
Mailing Address - Fax:
Practice Address - Street 1:34875 POURROY RD APT 1408
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8184
Practice Address - Country:US
Practice Address - Phone:281-795-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257939363LF0000X
TX35300722363LF0000X
CA95003191363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily