MEDICARE: SHERLEY MARDEL DAVID GRATIA PNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	9407209	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144747916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERLEY MARDEL DAVID GRATIA PNP-BC

Provider Business Mailing Address
First Line	:	4777 N CONGRESS AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-425-5085
Fax Number	:	561-209-5167

Provider Business Practice Location Address
First Line	:	4777 N CONGRESS AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-425-5085
Fax Number	:	561-209-5167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	01/03/2025

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