Provider Demographics
NPI:1639116841
Name:COLICA, SHARON ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANN
Last Name:COLICA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 WHITEKIRK PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8719
Mailing Address - Country:US
Mailing Address - Phone:951-331-5441
Mailing Address - Fax:
Practice Address - Street 1:9225 WHITEKIRK PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8719
Practice Address - Country:US
Practice Address - Phone:951-331-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2042213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250001944Medicaid