Provider Demographics
NPI:1467289488
Name:SCHIRES, MADISON TAYLOR
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR
Last Name:SCHIRES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E PILAR ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-4666
Mailing Address - Country:US
Mailing Address - Phone:352-697-0209
Mailing Address - Fax:
Practice Address - Street 1:101 E PILAR ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-4666
Practice Address - Country:US
Practice Address - Phone:352-697-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1163567106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician