Provider Demographics
NPI:1255475620
Name:ORNELLAS, SHARON KAY (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:ORNELLAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 OXFORD WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6447
Mailing Address - Country:US
Mailing Address - Phone:831-429-7450
Mailing Address - Fax:
Practice Address - Street 1:340 SOQUEL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2328
Practice Address - Country:US
Practice Address - Phone:831-429-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist