MEDICARE: SHARON LYNN NICHOLS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY13505	CA

General Provider Information

NPI Number	:	1548218753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LYNN NICHOLS PH.D.

Provider Business Mailing Address
First Line	:	12775 FAIRBROOK RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2270
Country	:	US
Telephone Number	:	858-689-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 GILMAN DR
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92093-5004
Country	:	US
Telephone Number	:	858-822-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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