Provider Demographics
NPI:1356740864
Name:OPTIMAL MOMENTS, LLC
Entity type:Organization
Organization Name:OPTIMAL MOMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:SADBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, CMPC
Authorized Official - Phone:813-538-0149
Mailing Address - Street 1:7819 N DALE MABRY HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3210
Mailing Address - Country:US
Mailing Address - Phone:813-538-0149
Mailing Address - Fax:844-371-0868
Practice Address - Street 1:7819 N DALE MABRY HWY STE 108
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3210
Practice Address - Country:US
Practice Address - Phone:813-538-0149
Practice Address - Fax:844-371-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201084420AMedicaid