Provider Demographics
NPI:1184082794
Name:WILEY, SHARON DENISE (MA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DENISE
Last Name:WILEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 S ESPANA ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5818
Mailing Address - Country:US
Mailing Address - Phone:720-435-6993
Mailing Address - Fax:303-237-6873
Practice Address - Street 1:4623 S ESPANA ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5818
Practice Address - Country:US
Practice Address - Phone:720-435-6993
Practice Address - Fax:303-237-6873
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27-3647565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO001363966Medicaid
CO27-3347565OtherEIN