Provider Demographics
NPI:1699933325
Name:MATTEU, SHARAE M (LMT)
Entity type:Individual
Prefix:MRS
First Name:SHARAE
Middle Name:M
Last Name:MATTEU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 PRINCELY AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1649
Mailing Address - Country:US
Mailing Address - Phone:904-234-3473
Mailing Address - Fax:
Practice Address - Street 1:4923 PRINCELY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1649
Practice Address - Country:US
Practice Address - Phone:904-234-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51995225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist