Healthcare Provider Details

I. General information

NPI: 1962619676
Provider Name (Legal Business Name): SHERYL LANG GELETKA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 BRADEN AVE SUITE #101
SARASOTA FL
34243-2053
US

IV. Provider business mailing address

373 BRADEN AVE SUITE #101
SARASOTA FL
34243-2053
US

V. Phone/Fax

Practice location:
  • Phone: 941-359-9090
  • Fax: 941-360-1595
Mailing address:
  • Phone: 941-359-9090
  • Fax: 941-360-1595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA42025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: