Healthcare Provider Details

I. General information

NPI: 1982154092
Provider Name (Legal Business Name): CHERYL PRIDE SORIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAITLAND AVE LIVEWELL OFFICE
ALTAMONTE SPRINGS FL
32701-4901
US

IV. Provider business mailing address

6612 ALADDIN DR
ORLANDO FL
32818-1370
US

V. Phone/Fax

Practice location:
  • Phone: 407-966-3400
  • Fax:
Mailing address:
  • Phone: 407-592-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: