Provider Demographics
NPI:1700107414
Name:QUENIMHERR, SHARMILA (MS)
Entity type:Individual
Prefix:
First Name:SHARMILA
Middle Name:
Last Name:QUENIMHERR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 W. 117TH ST.
Mailing Address - Street 2:4TH FL.
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2241
Mailing Address - Country:US
Mailing Address - Phone:310-838-1552
Mailing Address - Fax:310-838-1553
Practice Address - Street 1:4455 W. 117TH ST.
Practice Address - Street 2:4TH FL.
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-838-1552
Practice Address - Fax:310-838-1553
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA199811910063OtherSTATE