Healthcare Provider Details

I. General information

NPI: 1104703735
Provider Name (Legal Business Name): SHEREE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 DONALD AVE
SAN DIEGO CA
92117-3811
US

IV. Provider business mailing address

5998 ALCALA PARK
SAN DIEGO CA
92110-2492
US

V. Phone/Fax

Practice location:
  • Phone: 520-247-3404
  • Fax:
Mailing address:
  • Phone: 619-260-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number3808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: