Provider Demographics
NPI:1053459677
Name:WELD, SHARON D (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:D
Last Name:WELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 HOLIDAY CT STE 104
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1807
Mailing Address - Country:US
Mailing Address - Phone:858-452-4243
Mailing Address - Fax:858-450-5091
Practice Address - Street 1:3252 HOLIDAY CT STE 104
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1807
Practice Address - Country:US
Practice Address - Phone:858-452-4243
Practice Address - Fax:858-450-5091
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY124770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY124770Medicaid
CAPSY124770Medicaid