Healthcare Provider Details

I. General information

NPI: 1457511263
Provider Name (Legal Business Name): SABRINA M CACERES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 THE GREENS WAY 101
JACKSONVILLE FL
32250-2499
US

IV. Provider business mailing address

1538 THE GREENS WAY 101
JACKSONVILLE FL
32250-2499
US

V. Phone/Fax

Practice location:
  • Phone: 904-543-0161
  • Fax:
Mailing address:
  • Phone: 904-543-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberOS12362
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS12362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: