Healthcare Provider Details

I. General information

NPI: 1366732695
Provider Name (Legal Business Name): CHERYL BINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W OVERPAR DR
TAMPA FL
33612-5058
US

IV. Provider business mailing address

1710 W OVERPAR DR
TAMPA FL
33612-5058
US

V. Phone/Fax

Practice location:
  • Phone: 813-935-7614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: