Provider Demographics
NPI:1386372472
Name:MADEIRA, SHARLA
Entity type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:MADEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARLA
Other - Middle Name:
Other - Last Name:GLENN CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1111
Mailing Address - Country:US
Mailing Address - Phone:267-987-0641
Mailing Address - Fax:
Practice Address - Street 1:237 N 63RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1111
Practice Address - Country:US
Practice Address - Phone:267-987-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor