Provider Demographics
NPI:1306210968
Name:NWAKWESI, SHARLEEN
Entity Type:Individual
Prefix:
First Name:SHARLEEN
Middle Name:
Last Name:NWAKWESI
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 1:7225 RIVER HAMMOCK DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-4251
Mailing Address - Country:US
Mailing Address - Phone:813-422-3267
Mailing Address - Fax:
Practice Address - Street 1:7225 RIVER HAMMOCK DR UNIT 102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-4251
Practice Address - Country:US
Practice Address - Phone:813-422-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW130981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical