Provider Demographics
NPI:1346520236
Name:REED-DAVIS, SHAREN A (LPT)
Entity Type:Individual
Prefix:
First Name:SHAREN
Middle Name:A
Last Name:REED-DAVIS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 IMPERIAL HWY STE 116
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-8347
Mailing Address - Country:US
Mailing Address - Phone:562-651-5065
Mailing Address - Fax:562-406-1059
Practice Address - Street 1:12440 IMPERIAL HWY STE 116
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-8347
Practice Address - Country:US
Practice Address - Phone:562-651-5065
Practice Address - Fax:562-406-1059
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25061167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician