Healthcare Provider Details

I. General information

NPI: 1790108116
Provider Name (Legal Business Name): MATHEW SHARKAWY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PLACERVILLE DR STE 2
PLACERVILLE CA
95667-4200
US

IV. Provider business mailing address

3001 FLAMENCO WAY
ROSEVILLE CA
95747-4347
US

V. Phone/Fax

Practice location:
  • Phone: 530-644-2412
  • Fax:
Mailing address:
  • Phone: 209-534-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126339
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: