Provider Demographics
NPI:1457425746
Name:HENNESSEY, SHARON LEE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CHURCH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2689
Mailing Address - Country:US
Mailing Address - Phone:415-777-5277
Mailing Address - Fax:415-512-7540
Practice Address - Street 1:690 CHURCH ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2689
Practice Address - Country:US
Practice Address - Phone:415-777-5277
Practice Address - Fax:415-512-7540
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7774877Medicare UPIN