Provider Demographics
NPI:1891978185
Name:URICH, SHEREE GENEVIEVE (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHEREE
Middle Name:GENEVIEVE
Last Name:URICH
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 1:1304 OSPREY NEST LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7160
Mailing Address - Country:US
Mailing Address - Phone:386-767-6907
Mailing Address - Fax:
Practice Address - Street 1:1304 OSPREY NEST LN
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7160
Practice Address - Country:US
Practice Address - Phone:386-767-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68116796Medicaid