Healthcare Provider Details

I. General information

NPI: 1437715703
Provider Name (Legal Business Name): SHARON MICHELLE SCELZA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W STEWART AVE
MEDFORD OR
97501-3663
US

IV. Provider business mailing address

229 W STEWART AVE
MEDFORD OR
97501-3663
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-5531
  • Fax:
Mailing address:
  • Phone: 541-779-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200942873RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202000497NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: