MEDICARE: RACHELLE JONIQUE 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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1528827573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE JONIQUE SHARP

Provider Business Mailing Address
First Line	:	3500 NW 41ST ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4863
Country	:	US
Telephone Number	:	954-932-6283
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 NW 41ST ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4863
Country	:	US
Telephone Number	:	954-939-4880
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	08/14/2024

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