Provider Demographics
NPI:1376592147
Name:KARNAVAS, SHERRY M (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:M
Last Name:KARNAVAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 GOLDEN GATE PT
Mailing Address - Street 2:#502
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6627
Mailing Address - Country:US
Mailing Address - Phone:941-955-8168
Mailing Address - Fax:941-764-7984
Practice Address - Street 1:2866 TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5165
Practice Address - Country:US
Practice Address - Phone:941-764-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP20977Medicare UPIN
TX8A6577Medicare ID - Type Unspecified