=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457944522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARONDA DEANA PAUGH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2021
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11537 LAKE UNDERHILL RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-821-3098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3378 MONTANA CIR
-----------------------------------------------------
City | NORTH POLE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99705-6984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-695-6592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 22054
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------