Provider Demographics
NPI:1891443586
Name:VEGA RODRIGUEZ, SHERLY
Entity Type:Individual
Prefix:
First Name:SHERLY
Middle Name:
Last Name:VEGA RODRIGUEZ
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 1:3201 BUDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7203
Mailing Address - Country:US
Mailing Address - Phone:407-910-2941
Mailing Address - Fax:
Practice Address - Street 1:2291 SORRENTO CIR # 2291
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1197
Practice Address - Country:US
Practice Address - Phone:407-223-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner