Provider Demographics
NPI:1134397797
Name:MOHALE, SHARON MARGARET (PA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARGARET
Last Name:MOHALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:4244 RIVERWALK PKWY STE 170
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3373
Practice Address - Country:US
Practice Address - Phone:951-736-7432
Practice Address - Fax:951-736-7751
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052524363A00000X
CA54515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant