Healthcare Provider Details

I. General information

NPI: 1639424930
Provider Name (Legal Business Name): SHERIECE SADBERRY PH.D., LP, CMPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 N DALE MABRY HWY STE 108
TAMPA FL
33614-3210
US

IV. Provider business mailing address

7819 N DALE MABRY HWY STE 108
TAMPA FL
33614-3210
US

V. Phone/Fax

Practice location:
  • Phone: 813-538-0149
  • Fax: 844-371-0868
Mailing address:
  • Phone: 813-538-0149
  • Fax: 844-371-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2029
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number8416
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number2029
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: