Provider Demographics
NPI:1992219422
Name:HODGE-RADWAY, SHEEMA SHAKERA
Entity Type:Individual
Prefix:
First Name:SHEEMA
Middle Name:SHAKERA
Last Name:HODGE-RADWAY
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 1:45 NW 8TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4452
Mailing Address - Country:US
Mailing Address - Phone:305-246-0210
Mailing Address - Fax:305-246-0310
Practice Address - Street 1:45 NW 8TH ST STE 105
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4452
Practice Address - Country:US
Practice Address - Phone:305-246-0210
Practice Address - Fax:305-246-0310
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker