MEDICARE: KELLEY E SHERWOOD ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP9186304	FL

General Provider Information

NPI Number	:	1649606500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY E SHERWOOD ARNP

Provider Business Mailing Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 240
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3522
Country	:	US
Telephone Number	:	407-614-1644
Fax Number	:	407-614-1635

Provider Business Practice Location Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 240
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3522
Country	:	US
Telephone Number	:	407-614-1644
Fax Number	:	407-614-1635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	08/12/2014

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