Healthcare Provider Details

I. General information

NPI: 1306281175
Provider Name (Legal Business Name): SHERYL L STRATTON BROGDON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11181 HEALTH PARK BLVD STE 3000
NAPLES FL
34110-5743
US

IV. Provider business mailing address

2335 AARON ST
PORT CHARLOTTE FL
33952-5305
US

V. Phone/Fax

Practice location:
  • Phone: 239-430-5550
  • Fax: 239-430-5559
Mailing address:
  • Phone: 941-258-3295
  • Fax: 941-258-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: