Provider Demographics
NPI:1740773878
Name:CANALES, SHARON ISABEL (MS, BCBA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ISABEL
Last Name:CANALES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 SW 136TH ST APT 1108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5275
Mailing Address - Country:US
Mailing Address - Phone:786-424-4590
Mailing Address - Fax:
Practice Address - Street 1:12424 SW 94TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1845
Practice Address - Country:US
Practice Address - Phone:786-424-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-28757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017905400Medicaid