Provider Demographics
NPI:1477883734
Name:WEISS, SHERRY S
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:S
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:S
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4844 INVERNESS CT
Mailing Address - Street 2:104 SUITE
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-4103
Mailing Address - Country:US
Mailing Address - Phone:440-213-7485
Mailing Address - Fax:
Practice Address - Street 1:4844 INVERNESS CT
Practice Address - Street 2:104 SUITE
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-4103
Practice Address - Country:US
Practice Address - Phone:440-213-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230432251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health