Healthcare Provider Details

I. General information

NPI: 1013754639
Provider Name (Legal Business Name): EMILY ELIZABETH SHEARON B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 CAMINO DEL RIO S STE 101
SAN DIEGO CA
92108-4100
US

IV. Provider business mailing address

301 MAGENTA CT
ROSEVILLE CA
95747-4913
US

V. Phone/Fax

Practice location:
  • Phone: 619-775-1472
  • Fax:
Mailing address:
  • Phone: 916-517-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: