Healthcare Provider Details

I. General information

NPI: 1235328972
Provider Name (Legal Business Name): SHERRY LYNNE DAFTARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 12/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

IV. Provider business mailing address

3029 DONATO LN
DAVIS CA
95618-6554
US

V. Phone/Fax

Practice location:
  • Phone: 916-570-7229
  • Fax: 916-609-5160
Mailing address:
  • Phone: 530-758-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: