Provider Demographics
NPI:1972680890
Name:LAVENDER, SHERYL LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:LYNN
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ANCHOR PT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1777
Mailing Address - Country:US
Mailing Address - Phone:561-542-0188
Mailing Address - Fax:561-499-9983
Practice Address - Street 1:14610 MILITARY TRL
Practice Address - Street 2:SUITE-G-2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3797
Practice Address - Country:US
Practice Address - Phone:561-499-9981
Practice Address - Fax:561-499-9983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5562084N0400X, 2084P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS556OtherSTATE LICENSE
E81195Medicare UPIN