Healthcare Provider Details

I. General information

NPI: 1952477366
Provider Name (Legal Business Name): HEATHER SHERRY-ANNE LUING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 KINGSLEY LAKE DR STE 601
SAINT AUGUSTINE FL
32092-3042
US

IV. Provider business mailing address

150 SOUTHPARK BLVD STE 208
SAINT AUGUSTINE FL
32086-5179
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-4602
  • Fax: 904-217-4427
Mailing address:
  • Phone: 904-429-7076
  • Fax: 904-217-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME95498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: