MEDICARE: SHERRY VACCARO

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		FL

General Provider Information

NPI Number	:	1205705084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY VACCARO

Provider Business Mailing Address
First Line	:	15811 FENTON PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1651
Country	:	US
Telephone Number	:	813-310-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	15811 FENTON PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1651
Country	:	US
Telephone Number	:	813-310-0400
Fax Number	:

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

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	10/31/2025

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Directions to “ SHERRY VACCARO ” Practice Location

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