Provider Demographics
NPI:1639845233
Name:MENDEZ SHARP, KATHLEEN (RBT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MENDEZ SHARP
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 W 49TH PL APT 306A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-8125
Mailing Address - Country:US
Mailing Address - Phone:305-965-0751
Mailing Address - Fax:
Practice Address - Street 1:6941 SW 196TH AVE STE B29
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-1611
Practice Address - Country:US
Practice Address - Phone:954-999-5597
Practice Address - Fax:786-597-0516
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-174305106S00000X
FLOTA20165224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111373000Medicaid