Provider Demographics
NPI:1588808968
Name:MULLEN, SHERI LYNN (SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHERI
Middle Name:LYNN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60051
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-6051
Mailing Address - Country:US
Mailing Address - Phone:239-691-1555
Mailing Address - Fax:239-549-5585
Practice Address - Street 1:3046 DEL PRADO BLVD S STE 2A
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7215
Practice Address - Country:US
Practice Address - Phone:239-691-1555
Practice Address - Fax:239-549-5585
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174747489OtherMEDICARE GROUP UPIN