Healthcare Provider Details

I. General information

NPI: 1407989973
Provider Name (Legal Business Name): LISA A MERRITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST # 1700
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

677 N WASHINGTON BLVD
SARASOTA FL
34236-4241
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone: 941-225-8198
  • Fax: 941-906-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME97603
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG58307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: