=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871892828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MELISSA SHARP AND ASSOCIATES LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2011
-----------------------------------------------------
Last Update Date | 04/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1121 E MAIN ST SUITE 405
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-2205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-777-6333
-----------------------------------------------------
Fax | 630-444-1407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1121 E MAIN ST SUITE 405
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-2205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-777-6333
-----------------------------------------------------
Fax | 630-444-1407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MELISSA JANE SHARP
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 630-777-6333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 071006672
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 071006672
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------