Provider Demographics
NPI:1013306877
Name:NEWHOUSE, SIERRA JO
Entity Type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:JO
Last Name:NEWHOUSE
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 1:2916 ROCKINGHAM CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3309
Mailing Address - Country:US
Mailing Address - Phone:407-779-4175
Mailing Address - Fax:
Practice Address - Street 1:2916 ROCKINGHAM CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3309
Practice Address - Country:US
Practice Address - Phone:407-779-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17Other17