Provider Demographics
NPI:1720386733
Name:SUNDERLIN, SHEILA (LMT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SUNDERLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 PINELLAS POINT DR S
Mailing Address - Street 2:APT 13
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5425
Mailing Address - Country:US
Mailing Address - Phone:727-637-5431
Mailing Address - Fax:
Practice Address - Street 1:7158 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5935
Practice Address - Country:US
Practice Address - Phone:727-392-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist