Provider Demographics
NPI:1669960720
Name:SHARIPOV, ALEKSEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEKSEY
Middle Name:
Last Name:SHARIPOV
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 FAIR OAKS BLVD APT 195
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3381
Mailing Address - Country:US
Mailing Address - Phone:916-606-3355
Mailing Address - Fax:
Practice Address - Street 1:5709 MARCONI AVE STE E
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4585
Practice Address - Country:US
Practice Address - Phone:916-606-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29881103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist