Provider Demographics
NPI:1659080463
Name:CAMATA, SHERRY LYN PAREL
Entity Type:Individual
Prefix:
First Name:SHERRY LYN
Middle Name:PAREL
Last Name:CAMATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 CHANCELLOR DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8178
Mailing Address - Country:US
Mailing Address - Phone:904-322-1271
Mailing Address - Fax:
Practice Address - Street 1:4600 MIDDLETON PARK CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5691
Practice Address - Country:US
Practice Address - Phone:904-322-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT250132251N0400X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9043221271Medicaid