Provider Demographics
NPI:1255847653
Name:LOUDD, SHARELLE NICOLE (CERTIFIED HAIR-LOSS)
Entity Type:Individual
Prefix:
First Name:SHARELLE
Middle Name:NICOLE
Last Name:LOUDD
Suffix:
Gender:F
Credentials:CERTIFIED HAIR-LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5914
Mailing Address - Country:US
Mailing Address - Phone:408-685-4225
Mailing Address - Fax:
Practice Address - Street 1:1186 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5914
Practice Address - Country:US
Practice Address - Phone:408-460-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK4820641744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management