Healthcare Provider Details

I. General information

NPI: 1366641813
Provider Name (Legal Business Name): SHEILA A GLEASON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2007
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 BAYSIDE WALK
SAN DIEGO CA
92109-6948
US

IV. Provider business mailing address

P.O BOX 864 GRAND AVE
SAN DIEGO CA
92109-6948
US

V. Phone/Fax

Practice location:
  • Phone: 858-488-5528
  • Fax:
Mailing address:
  • Phone: 858-692-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number13685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: