Provider Demographics
NPI:1982898540
Name:WALLACE, SHARON SIMARA (HS)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:SIMARA
Last Name:WALLACE
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2870
Mailing Address - Country:US
Mailing Address - Phone:808-780-7038
Mailing Address - Fax:
Practice Address - Street 1:202 BLOSSOM CT
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2870
Practice Address - Country:US
Practice Address - Phone:808-780-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other