Provider Demographics
NPI:1588670087
Name:STANSBERRY, SHERIL K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIL
Middle Name:K
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N LAKEMONT AVE
Mailing Address - Street 2:2C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3213
Mailing Address - Country:US
Mailing Address - Phone:407-740-7710
Mailing Address - Fax:407-740-7713
Practice Address - Street 1:111 N LAKEMONT AVE
Practice Address - Street 2:2C
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3213
Practice Address - Country:US
Practice Address - Phone:407-740-7710
Practice Address - Fax:407-740-7713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
K2009Medicare ID - Type Unspecified
D21036Medicare UPIN