Provider Demographics
NPI:1205659646
Name:PEREZ, SHERRY NICOLE
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:NICOLE
Last Name:PEREZ
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 1:1200 DEER MOSS LOOP APT 2107
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3448
Mailing Address - Country:US
Mailing Address - Phone:843-227-0098
Mailing Address - Fax:
Practice Address - Street 1:1001 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6943
Practice Address - Country:US
Practice Address - Phone:850-400-6098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-390653106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician