Provider Demographics
NPI:1851584692
Name:BURRIS, SHERRY D
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:D
Last Name:BURRIS
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 1:10022 WATER WORKS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5301
Mailing Address - Country:US
Mailing Address - Phone:813-663-9828
Mailing Address - Fax:813-677-5029
Practice Address - Street 1:10022 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5301
Practice Address - Country:US
Practice Address - Phone:813-663-9828
Practice Address - Fax:813-677-5029
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist