Healthcare Provider Details

I. General information

NPI: 1134419815
Provider Name (Legal Business Name): DR. SHERYL P. DE LEON-DIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 EMERALD COAST PKWY W
MIRAMAR BEACH FL
32550-7274
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-278-3885
  • Fax: 850-278-3832
Mailing address:
  • Phone: 850-475-4500
  • Fax: 850-475-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME129327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: