Provider Demographics
NPI:1891874426
Name:MADDIX, SHARIFA K (MD)
Entity Type:Individual
Prefix:
First Name:SHARIFA
Middle Name:K
Last Name:MADDIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W HIBISCUS BLVD STE 131
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2633
Mailing Address - Country:US
Mailing Address - Phone:321-234-4200
Mailing Address - Fax:
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 131
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-234-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME97053OtherMEDICAL LICENSE