Healthcare Provider Details

I. General information

NPI: 1174717649
Provider Name (Legal Business Name): SHARON LINDSAY CLANCY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 BRIGGS AVE
LA CRESCENTA CA
91214
US

IV. Provider business mailing address

1145 BROADWAY
SEATTLE WA
98122-4201
US

V. Phone/Fax

Practice location:
  • Phone: 818-275-3758
  • Fax:
Mailing address:
  • Phone: 206-860-5414
  • Fax: 206-720-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA91365
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2018-02285
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: