Provider Demographics
NPI:1134576564
Name:WHITE, SHERYL
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:WHITE
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 1:5861 JACKSON LN
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-6808
Mailing Address - Country:US
Mailing Address - Phone:941-800-4470
Mailing Address - Fax:
Practice Address - Street 1:12497 TAMIAMI TRL S
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1447
Practice Address - Country:US
Practice Address - Phone:941-492-4300
Practice Address - Fax:941-492-2170
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health