Provider Demographics
NPI:1679865992
Name:KELLEY, SHARON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 N. SHERMAN AVE
Mailing Address - Street 2:SUITE 334
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704
Mailing Address - Country:US
Mailing Address - Phone:608-561-7230
Mailing Address - Fax:855-844-8988
Practice Address - Street 1:1213 N. SHERMAN AVE
Practice Address - Street 2:SUITE 334
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704
Practice Address - Country:US
Practice Address - Phone:617-626-9592
Practice Address - Fax:617-626-9578
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8575103T00000X
WI3100-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist