Provider Demographics
NPI:1417712431
Name:TAWADROS, SHERRY MINA MOREED
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MINA MOREED
Last Name:TAWADROS
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 1:1356 THE 12TH FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5741
Mailing Address - Country:US
Mailing Address - Phone:561-601-9257
Mailing Address - Fax:
Practice Address - Street 1:1356 THE 12TH FAIRWAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5741
Practice Address - Country:US
Practice Address - Phone:561-601-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist