Healthcare Provider Details

I. General information

NPI: 1710410337
Provider Name (Legal Business Name): SHARONDA CARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARHONDA CARNEY

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 MARCONI AVE
SACRAMENTO CA
95821-3867
US

IV. Provider business mailing address

3815 MARCONI AVE
SACRAMENTO CA
95821-3867
US

V. Phone/Fax

Practice location:
  • Phone: 916-890-3000
  • Fax:
Mailing address:
  • Phone: 916-890-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT41932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: