MEDICARE: SHERRY B LEIB PHD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY6080	FL

General Provider Information

NPI Number	:	1609015619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERRY B LEIB PHD PA

Provider Business Mailing Address
First Line	:	2953 W KNIGHTS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1662
Country	:	US
Telephone Number	:	813-892-6868
Fax Number	:	866-469-3880

Provider Business Practice Location Address
First Line	:	4230 S MACDILL AVE
Second Line	:	SUITE 223
City	:	TAMPA
State	:	FL
Zip	:	33611-1901
Country	:	US
Telephone Number	:	813-892-6868
Fax Number	:	866-469-3880

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRY LEIB
Credential	:	PHD
Telephone Number	:	813-892-6868

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/13/2009

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