1558797498 NPI number — SHERRY SANDERS REEVES, PSYD, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558797498 NPI number — SHERRY SANDERS REEVES, PSYD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRY SANDERS REEVES, PSYD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1558797498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
870 CLARK ST, STE 1020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-9270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-701-1135
Provider Business Mailing Address Fax Number:
407-542-1804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 CLARK ST, STE 1020
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-9270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-701-1135
Provider Business Practice Location Address Fax Number:
407-542-1804
Provider Enumeration Date:
09/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
SANDERS
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
407-701-1135

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HO470A , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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