Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Raychelle Sheryl Wallace

Individual provider Community/Behavioral Health Agency · NPI 1609464098

Raychelle Sheryl Wallace is a Community/Behavioral Health Agency in Brandon, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2021
Specialties on file
6

Practice location Address checks out

673 W Lumsden Rd
Brandon, FL 33511-5911
Phone: (813) 798-0800
Fax: (813) 798-7800
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence MH19813 (FL)
Community/Behavioral Health Agency Taxonomy 251S00000X · Licence IMH18337 (FL)
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X · Licence IMH18337 (FL)
Case Management Agency Taxonomy 251B00000X · Licence IMH18337 (FL)
Adult Mental Health Clinic/Center Taxonomy 261QM0850X · Licence IMH18337 (FL)
Adolescent and Children Mental Health Clinic/Center Taxonomy 261QM0855X · Licence IMH18337 (FL)

Record details

NPI number1609464098
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 2, 2021
Last updated in NPPESAugust 14, 2023
Certification dateAugust 12, 2023
Mailing address11705 Boyette Rd, Pmb 430, Riverview, FL 33569

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