Healthcare Provider Details

I. General information

NPI: 1528029857
Provider Name (Legal Business Name): SHARI LYN SIPKA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 WINNETKA AVE
WOODLAND HILLS CA
91371-0001
US

IV. Provider business mailing address

5565 OCEAN UNIT 103
HAWTHORNE CA
90250-1114
US

V. Phone/Fax

Practice location:
  • Phone: 818-710-4385
  • Fax:
Mailing address:
  • Phone: 407-973-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: