Provider Demographics
NPI:1447606900
Name:MADDOX, SHARDE
Entity Type:Individual
Prefix:
First Name:SHARDE
Middle Name:
Last Name: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 1:2633 CEDAR TREE RD APT D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-0116
Mailing Address - Country:US
Mailing Address - Phone:405-923-5980
Mailing Address - Fax:
Practice Address - Street 1:2633 CEDAR TREE RD APT D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-0116
Practice Address - Country:US
Practice Address - Phone:405-923-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator