Healthcare Provider Details

I. General information

NPI: 1881384402
Provider Name (Legal Business Name): SHERMAINE HUMPHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 ENTERPRISE RD STE 105
DEBARY FL
32713-2753
US

IV. Provider business mailing address

2720 W 18TH ST
SANFORD FL
32771-3011
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-5413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: