Provider Demographics
NPI:1538050026
Name:ALLY, SHARA (DNP, PMHNP-BC, MBA)
Entity type:Individual
Prefix:
First Name:SHARA
Middle Name:
Last Name:ALLY
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 S COAST HWY
Mailing Address - Street 2:4097
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651
Mailing Address - Country:US
Mailing Address - Phone:647-545-8896
Mailing Address - Fax:
Practice Address - Street 1:1968 S COAST HWY
Practice Address - Street 2:4097
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:647-545-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13060363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health