Healthcare Provider Details

I. General information

NPI: 1871892828
Provider Name (Legal Business Name): DR MELISSA SHARP AND ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E MAIN ST SUITE 405
SAINT CHARLES IL
60174-2205
US

IV. Provider business mailing address

1121 E MAIN ST SUITE 405
SAINT CHARLES IL
60174-2205
US

V. Phone/Fax

Practice location:
  • Phone: 630-777-6333
  • Fax: 630-444-1407
Mailing address:
  • Phone: 630-777-6333
  • Fax: 630-444-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number071006672
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number071006672
License Number StateIL

VIII. Authorized Official

Name: DR. MELISSA JANE SHARP
Title or Position: OWNER
Credential: PSYD
Phone: 630-777-6333