Provider Demographics
NPI:1710410337
Name:CARNEY, SHARONDA
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:
Last Name:CARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARHONDA
Other - Middle Name:
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3815 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3867
Mailing Address - Country:US
Mailing Address - Phone:916-890-3000
Mailing Address - Fax:
Practice Address - Street 1:3815 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3867
Practice Address - Country:US
Practice Address - Phone:916-890-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CAPT41932167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner