Provider Demographics
NPI:1104085869
Name:PUNIVAI, SHARON (MC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:PUNIVAI
Suffix:
Gender:F
Credentials:MC
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC
Mailing Address - Street 1:33 NW BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3580
Mailing Address - Country:US
Mailing Address - Phone:503-228-7134
Mailing Address - Fax:503-445-0749
Practice Address - Street 1:33 NW BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3580
Practice Address - Country:US
Practice Address - Phone:503-228-7134
Practice Address - Fax:503-445-0749
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539372-10Medicaid