Provider Demographics
NPI:1477089274
Name:SARDONYX GROUP THERAPY INC
Entity Type:Organization
Organization Name:SARDONYX GROUP THERAPY INC
Other - Org Name:CHILDREN'S WORLD THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONNE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:BROWN-O'MEALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-266-9013
Mailing Address - Street 1:4320 W BROWARD BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3756
Mailing Address - Country:US
Mailing Address - Phone:954-266-9013
Mailing Address - Fax:786-257-5686
Practice Address - Street 1:4320 W BROWARD BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3756
Practice Address - Country:US
Practice Address - Phone:954-266-9013
Practice Address - Fax:855-941-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023552400Medicaid
FL016647600Medicaid