Provider Demographics
NPI:1669696563
Name:SIMAS, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SIMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1779
Mailing Address - Country:US
Mailing Address - Phone:209-644-6320
Mailing Address - Fax:209-644-6336
Practice Address - Street 1:102 W BIANCHI RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-7132
Practice Address - Country:US
Practice Address - Phone:209-644-6320
Practice Address - Fax:209-644-6336
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)