Provider Demographics
NPI:1326653718
Name:SHERMAN, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SHERMAN
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 1:10135 GATE PKWY N APT 1516
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8267
Mailing Address - Country:US
Mailing Address - Phone:954-224-8216
Mailing Address - Fax:800-396-7959
Practice Address - Street 1:10135 GATE PKWY N SUITE 1516
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8267
Practice Address - Country:US
Practice Address - Phone:352-658-1016
Practice Address - Fax:800-396-7959
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251E00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023543700Medicaid