Provider Demographics
NPI:1134488455
Name:SHERREL, VICTOR THOMAS (MD,)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:THOMAS
Last Name:SHERREL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 BAYOU BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2162
Mailing Address - Country:US
Mailing Address - Phone:850-476-0977
Mailing Address - Fax:
Practice Address - Street 1:5190 BAYOU BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2162
Practice Address - Country:US
Practice Address - Phone:850-476-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1323832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program