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General NPI Number Information
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NPI Number | 1356644991
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Entity Type | Organization
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Legal Business Name | SHERRY V, RISCH, PH.D,. P.A.
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 2120 U S 1 SOUTH
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-794-2007
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Fax | 904-794-2033
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Provider Business Mailing Address
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Address Line | 2120 U S 1 SOUTH
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-794-2007
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Fax | 904-794-2033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHERRY V RISCH
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Credential | PH. D.
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Telephone | 904-794-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY4553
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License Number State | FL
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