Provider Demographics
NPI:1477500684
Name:CHAPPELL, SHARILYN ROSE (PA C)
Entity type:Individual
Prefix:MRS
First Name:SHARILYN
Middle Name:ROSE
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:7101 PARK ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4632
Practice Address - Country:US
Practice Address - Phone:727-397-1559
Practice Address - Fax:727-391-0838
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290677500Medicaid
FLE2722XMedicare PIN
FL290677500Medicaid