MEDICARE: MS. DEENA SHEILA SHARP

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	235Z00000X	Speech-Language Pathologist	SP 1468	CA

General Provider Information

NPI Number	:	1992040661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEENA SHEILA SHARP

Provider Business Mailing Address
First Line	:	6303 OWENSMOUTH AVE
Second Line	:	FL 10 DIRECTED SPECIALIZED SERVICES
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367
Country	:	US
Telephone Number	:	323-391-1622
Fax Number	:	323-391-1622

Provider Business Practice Location Address
First Line	:	6303 OWENSMOUTH AVE
Second Line	:	FL 10
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2264
Country	:	US
Telephone Number	:	323-391-1622
Fax Number	:	323-391-1622

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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