Provider Demographics
NPI:1962064022
Name:GEDAN, SHARON (RN, MS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GEDAN
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 BEVERLY BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4532
Mailing Address - Country:US
Mailing Address - Phone:323-651-4225
Mailing Address - Fax:
Practice Address - Street 1:8170 BEVERLY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4532
Practice Address - Country:US
Practice Address - Phone:323-651-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1553356163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty