Provider Demographics
NPI:1477024834
Name:VELEZ, SHARON ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:VELEZ
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 1:7007 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-3511
Mailing Address - Country:US
Mailing Address - Phone:813-728-8214
Mailing Address - Fax:813-884-7393
Practice Address - Street 1:7007 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-3511
Practice Address - Country:US
Practice Address - Phone:813-728-8214
Practice Address - Fax:813-884-7393
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000751053747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020033200Medicaid