Healthcare Provider Details

I. General information

NPI: 1346462264
Provider Name (Legal Business Name): NEIL K SHERWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SILVER STAR RD
ORLANDO FL
32808
US

IV. Provider business mailing address

6200 SILVER STAR RD
ORLANDO FL
32808
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-9500
  • Fax: 407-290-9501
Mailing address:
  • Phone: 407-296-9500
  • Fax: 407-290-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO2291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: