Healthcare Provider Details

I. General information

NPI: 1477500684
Provider Name (Legal Business Name): SHARILYN ROSE CHAPPELL PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 PARK ST
SEMINOLE FL
33777-4632
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-1559
  • Fax: 727-391-0838
Mailing address:
  • Phone: 727-823-2188
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: