Provider Demographics
NPI:1255509758
Name:SHAMP, SHERRY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LYNN
Last Name:SHAMP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 BAHIA VISTA ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2422
Mailing Address - Country:US
Mailing Address - Phone:941-957-4478
Mailing Address - Fax:941-951-1098
Practice Address - Street 1:3737 BAHIA VISTA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2422
Practice Address - Country:US
Practice Address - Phone:941-957-4478
Practice Address - Fax:941-951-1098
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4689OtherMEDICARE PTAN