Healthcare Provider Details

I. General information

NPI: 1114855012
Provider Name (Legal Business Name): SHARON MARIE CRANWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 AERO CT
SAN DIEGO CA
92123-2199
US

IV. Provider business mailing address

3585 AERO CT APT 310
SAN DIEGO CA
92123-2877
US

V. Phone/Fax

Practice location:
  • Phone: 845-416-0833
  • Fax:
Mailing address:
  • Phone: 845-416-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: