Healthcare Provider Details

I. General information

NPI: 1649426008
Provider Name (Legal Business Name): SHERELL EDWARDS DR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERELL EDWARDS ED.D

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/10/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 ARLINGTON EXPY STE B1052208
JACKSONVILLE FL
32211-5779
US

IV. Provider business mailing address

6501 ARLINGTON EXPY STE B1052208
JACKSONVILLE FL
32211-5779
US

V. Phone/Fax

Practice location:
  • Phone: 321-710-6568
  • Fax:
Mailing address:
  • Phone: 321-710-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number22-2016
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: