Provider Demographics
NPI:1609223585
Name:BOLDING, SHARADYN LYNAE (MS)
Entity Type:Individual
Prefix:
First Name:SHARADYN
Middle Name:LYNAE
Last Name:BOLDING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W SHAW AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3708
Mailing Address - Country:US
Mailing Address - Phone:559-681-1947
Mailing Address - Fax:559-860-0130
Practice Address - Street 1:1100 W SHAW AVE STE 130
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3708
Practice Address - Country:US
Practice Address - Phone:559-681-1947
Practice Address - Fax:559-860-0130
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)