Provider Demographics
NPI:1629044417
Name:NELSON, SHARON E (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLVD
Mailing Address - Street 2:350
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:818-790-8121
Mailing Address - Fax:818-952-0926
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:350
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-8121
Practice Address - Fax:818-952-0926
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48275207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92804Medicare UPIN
W4264Medicare ID - Type Unspecified