Healthcare Provider Details

I. General information

NPI: 1285701060
Provider Name (Legal Business Name): SHEREE WATEROUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 JFK DR SUITE A
ATLANTIS FL
33462-1151
US

IV. Provider business mailing address

5700 LAKE WORTH RD SUITE 204
GREENACRES FL
33463-4727
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-8935
  • Fax: 561-432-8937
Mailing address:
  • Phone: 561-968-7968
  • Fax: 561-432-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: