Provider Demographics
NPI:1619187259
Name:PERUGINI, SHARON MIERAS (PHD, EDS, MA)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MIERAS
Last Name:PERUGINI
Suffix:
Gender:F
Credentials:PHD, EDS, MA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:MIERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7595
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7595
Mailing Address - Country:US
Mailing Address - Phone:480-605-0413
Mailing Address - Fax:
Practice Address - Street 1:2850 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1004
Practice Address - Country:US
Practice Address - Phone:602-338-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23752103T00000X
AZ4417103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist