Provider Demographics
NPI:1144505330
Name:NICOLE SHARKEY, MD, INC
Entity type:Organization
Organization Name:NICOLE SHARKEY, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-394-6222
Mailing Address - Street 1:1110 W LA PALMA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2822
Mailing Address - Country:US
Mailing Address - Phone:714-808-0917
Mailing Address - Fax:714-808-9326
Practice Address - Street 1:1110 W LA PALMA AVE STE 5
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2822
Practice Address - Country:US
Practice Address - Phone:714-808-0917
Practice Address - Fax:714-808-9326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty