Provider Demographics
NPI:1316032501
Name:THARES-CALLAWAY, SHEILA MICHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:MICHELLE
Last Name:THARES-CALLAWAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 SAMARITAN DRIVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1341
Mailing Address - Country:US
Mailing Address - Phone:408-358-3715
Mailing Address - Fax:
Practice Address - Street 1:19000 HOMESTEAD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-366-4200
Practice Address - Fax:408-366-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health