Provider Demographics
NPI:1831116292
Name:OKUHARA, SHERYL V (DO)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:V
Last Name:OKUHARA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:A
Other - Last Name:VILLENEUVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:941-216-3939
Mailing Address - Fax:
Practice Address - Street 1:1854 RYE ROAD EAST
Practice Address - Street 2:UNIT E
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:941-216-3939
Practice Address - Fax:941-782-3441
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07898800207R00000X
FLOS9006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16565OtherBCBS
FL16565OtherBCBS
FLU4446XMedicare PIN