Provider Demographics
NPI:1073245155
Name:BAKER, SHERYAL
Entity Type:Individual
Prefix:
First Name:SHERYAL
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11018 SILVER DANCER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2351
Mailing Address - Country:US
Mailing Address - Phone:813-384-0953
Mailing Address - Fax:866-675-0661
Practice Address - Street 1:11018 SILVER DANCER DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2351
Practice Address - Country:US
Practice Address - Phone:813-384-0953
Practice Address - Fax:866-675-0661
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5178977164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN5178977OtherLICENSED PRACTICAL NURSE