1578178059 NPI number — SHERRY THI HUGHES

Table of content: SHERRY THI HUGHES (NPI 1578178059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578178059 NPI number — SHERRY THI HUGHES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHES
Provider First Name:
SHERRY
Provider Middle Name:
THI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578178059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5707 N 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33610-4350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-239-8069
Provider Business Mailing Address Fax Number:
813-231-7324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 N PIERCE ST STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33602-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-624-8852
Provider Business Practice Location Address Fax Number:
813-301-3819
Provider Enumeration Date:
09/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)