Provider Demographics
NPI:1356673677
Name:PELLE, SHARON ELAINE
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELAINE
Last Name:PELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:ELAINE
Other - Last Name:PELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, CMT
Mailing Address - Street 1:1029 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2225
Mailing Address - Country:US
Mailing Address - Phone:510-814-7287
Mailing Address - Fax:510-526-4120
Practice Address - Street 1:1029 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2225
Practice Address - Country:US
Practice Address - Phone:510-814-7287
Practice Address - Fax:510-526-4120
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0900047614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist