Provider Demographics
NPI:1578604237
Name:WOLLASTON, SHARON MARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MARLENE
Last Name:WOLLASTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4517 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4134
Mailing Address - Country:US
Mailing Address - Phone:818-985-7334
Mailing Address - Fax:818-972-9067
Practice Address - Street 1:1411 N HOLLYWOOD WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1826
Practice Address - Country:US
Practice Address - Phone:818-841-9990
Practice Address - Fax:818-972-9067
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA064194208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics