MEDICARE: SHERELYN CRUZ-RODRIGUEZ

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710766647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERELYN CRUZ-RODRIGUEZ

Provider Business Mailing Address
First Line	:	2569 FORBES ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4261
Country	:	US
Telephone Number	:	912-202-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 SOUTHSIDE BLVD UNIT 900
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0793
Country	:	US
Telephone Number	:	904-732-4343
Fax Number	:

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

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	05/11/2026

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Directions to “ SHERELYN CRUZ-RODRIGUEZ ” Practice Location

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