Provider Demographics
NPI:1639506611
Name:DEROME, SABRINA M
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:M
Last Name:DEROME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:M
Other - Last Name:TELLSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4617 SUMMER OAK AVE E
Mailing Address - Street 2:#831
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4983
Mailing Address - Country:US
Mailing Address - Phone:941-323-2224
Mailing Address - Fax:
Practice Address - Street 1:4630 17TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-1843
Practice Address - Country:US
Practice Address - Phone:941-487-5400
Practice Address - Fax:941-487-5430
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD650793827560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker