MEDICARE: MISS SHARAYNE LETIZA DOUGLAS

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	101YM0800X	Mental Health Counselor
2	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1952882383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHARAYNE LETIZA DOUGLAS

Provider Business Mailing Address
First Line	:	410 SW 81ST TER
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-1018
Country	:	US
Telephone Number	:	954-632-9132
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NW 101ST LN # 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3930
Country	:	US
Telephone Number	:	954-632-9132
Fax Number	:

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

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	09/10/2024

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