Healthcare Provider Details

I. General information

NPI: 1568851699
Provider Name (Legal Business Name): SALLYANN INCHERCHERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALLYANN MARCHI PA-C

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8934 CONROY WINDERMERE RD
ORLANDO FL
32835-3128
US

IV. Provider business mailing address

10140 CENTURION PKWY N FL PROVIDER
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-0082
  • Fax: 407-374-1637
Mailing address:
  • Phone: 904-697-3600
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003462
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057324
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109220
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: