Healthcare Provider Details

I. General information

NPI: 1659080463
Provider Name (Legal Business Name): SHERRY LYN PAREL CAMATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MIDDLETON PARK CIR E
JACKSONVILLE FL
32224-5691
US

IV. Provider business mailing address

573 CHANCELLOR DR W
JACKSONVILLE FL
32225-8178
US

V. Phone/Fax

Practice location:
  • Phone: 904-322-1271
  • Fax:
Mailing address:
  • Phone: 904-322-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT25013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT25013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: