Provider Demographics
NPI:1497951792
Name:BOAZ, SHERRY LYNN (RT(R), RDMS)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:BOAZ
Suffix:
Gender:F
Credentials:RT(R), RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 LANTERN CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1413
Mailing Address - Country:US
Mailing Address - Phone:321-289-3041
Mailing Address - Fax:
Practice Address - Street 1:3067 LANTERN CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1413
Practice Address - Country:US
Practice Address - Phone:321-289-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL795802471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography