Provider Demographics
NPI:1154161529
Name:GILL, SHARAN (MSN PMHNP)
Entity type:Individual
Prefix:
First Name:SHARAN
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:MSN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17853 SANTIAGO BLVD STE 107-214
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4113
Mailing Address - Country:US
Mailing Address - Phone:657-246-2337
Mailing Address - Fax:
Practice Address - Street 1:1225 W 190TH ST STE 470
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4316
Practice Address - Country:US
Practice Address - Phone:877-515-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health