Healthcare Provider Details

I. General information

NPI: 1770750655
Provider Name (Legal Business Name): SHERRY K HANNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERIEN K BOTTROS M.D

II. Dates (important events)

Enumeration Date: 05/10/2008
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W COCOA BEACH CSWY
COCOA BEACH FL
32931-3585
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-868-5871
  • Fax: 321-868-5852
Mailing address:
  • Phone: 321-868-5871
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME131622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: