Healthcare Provider Details

I. General information

NPI: 1134488455
Provider Name (Legal Business Name): VICTOR THOMAS SHERREL M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 BAYOU BLVD STE 6
PENSACOLA FL
32503-2162
US

IV. Provider business mailing address

5190 BAYOU BLVD STE 6
PENSACOLA FL
32503-2162
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0977
  • Fax:
Mailing address:
  • Phone: 850-476-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME132383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: