Provider Demographics
NPI:1073244760
Name:PAPALEO-MADDOX, SHARICE CAMIELLE
Entity Type:Individual
Prefix:
First Name:SHARICE
Middle Name:CAMIELLE
Last Name:PAPALEO-MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2546
Mailing Address - Country:US
Mailing Address - Phone:386-275-2545
Mailing Address - Fax:
Practice Address - Street 1:1145 SHADY OAK LN
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2546
Practice Address - Country:US
Practice Address - Phone:386-275-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT22216041106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP145783925900OtherDRIVERS LICENSE