1790785707 NPI number — DR. SHERRI FAIR CAPLAN DO

Table of content: DR. SHERRI FAIR CAPLAN DO (NPI 1790785707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790785707 NPI number — DR. SHERRI FAIR CAPLAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPLAN
Provider First Name:
SHERRI
Provider Middle Name:
FAIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAIR
Provider Other First Name:
SHERRI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790785707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 S FISKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-868-2778
Provider Business Mailing Address Fax Number:
321-951-7408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 VIDINA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-7698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-471-1068
Provider Business Practice Location Address Fax Number:
321-434-9285
Provider Enumeration Date:
08/01/2005

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: 207V00000X , with the licence number:  OS8369 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 261204600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58747Y . This is a "HFMG MA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261204600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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