Provider Demographics
NPI:1477815256
Name:BRODERICK, SHARALEEN PEYCKE
Entity Type:Individual
Prefix:
First Name:SHARALEEN
Middle Name:PEYCKE
Last Name:BRODERICK
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 1:2575 WESTMINSTER TER
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7568
Mailing Address - Country:US
Mailing Address - Phone:407-496-2630
Mailing Address - Fax:
Practice Address - Street 1:1414 LEXINGTON GREEN LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1015
Practice Address - Country:US
Practice Address - Phone:407-496-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator