Healthcare Provider Details

I. General information

NPI: 1720002116
Provider Name (Legal Business Name): SHERRY RALSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E FOWLER AVE
TAMPA FL
33620-4619
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8038
  • Fax: 813-974-4325
Mailing address:
  • Phone: 813-821-8038
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number114521
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1512
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: