Provider Demographics
NPI:1578046868
Name:TIMBERLAKE, SADE EVELYN
Entity Type:Individual
Prefix:MS
First Name:SADE
Middle Name:EVELYN
Last Name:TIMBERLAKE
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 1:2995 W MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4654
Mailing Address - Country:US
Mailing Address - Phone:407-520-6878
Mailing Address - Fax:
Practice Address - Street 1:2995 W MAIN ST APT 3
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4654
Practice Address - Country:US
Practice Address - Phone:407-520-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care