Provider Demographics
NPI:1578773586
Name:STUPAY, SHARON LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEE
Last Name:STUPAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 DUNBAR AVE APT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-5185
Mailing Address - Country:US
Mailing Address - Phone:714-369-8312
Mailing Address - Fax:
Practice Address - Street 1:4655 RUFFNER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2275
Practice Address - Country:US
Practice Address - Phone:714-369-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant