Provider Demographics
NPI:1649697764
Name:SHARPE, LEILANI M (MD, PHD)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:M
Last Name:SHARPE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 6TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3345
Mailing Address - Country:US
Mailing Address - Phone:310-707-2500
Mailing Address - Fax:310-707-2501
Practice Address - Street 1:222 W 6TH ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731
Practice Address - Country:US
Practice Address - Phone:310-707-2500
Practice Address - Fax:310-707-2501
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1327592084P0804X
CAA1413242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry