Provider Demographics
NPI:1912784190
Name:MILLER, SHARDE RENAE
Entity Type:Individual
Prefix:
First Name:SHARDE
Middle Name:RENAE
Last Name:MILLER
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 1:1812 MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-2136
Mailing Address - Country:US
Mailing Address - Phone:205-427-7942
Mailing Address - Fax:
Practice Address - Street 1:1812 MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-2136
Practice Address - Country:US
Practice Address - Phone:205-427-7942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool