Provider Demographics
NPI:1508923004
Name:RIDELLA-MEHLOS, SHARON JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JEAN
Last Name:RIDELLA-MEHLOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2326
Mailing Address - Country:US
Mailing Address - Phone:734-243-2316
Mailing Address - Fax:
Practice Address - Street 1:22 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2326
Practice Address - Country:US
Practice Address - Phone:734-243-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical