Provider Demographics
NPI:1265859763
Name:SHIELDS, SHARON
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:SHIELDS
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 1:634 PRESSLEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5526
Mailing Address - Country:US
Mailing Address - Phone:707-484-1326
Mailing Address - Fax:707-570-3945
Practice Address - Street 1:634 PRESSLEY ST
Practice Address - Street 2:#14
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5526
Practice Address - Country:US
Practice Address - Phone:707-484-1326
Practice Address - Fax:707-570-3745
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133152II101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health