Provider Demographics
NPI:1699365874
Name:SHAARDA, ADRIANA JAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:JAE
Last Name:SHAARDA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 GULF RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-2323
Mailing Address - Country:US
Mailing Address - Phone:231-920-9225
Mailing Address - Fax:
Practice Address - Street 1:3650 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8321
Practice Address - Country:US
Practice Address - Phone:850-995-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist