Provider Demographics
NPI:1649426008
Name:EDWARDS, SHERELL (DR)
Entity type:Individual
Prefix:
First Name:SHERELL
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DR
Other - Prefix:DR
Other - First Name:SHERELL
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:6501 ARLINGTON EXPY STE B1052208
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5779
Mailing Address - Country:US
Mailing Address - Phone:321-710-6568
Mailing Address - Fax:
Practice Address - Street 1:6501 ARLINGTON EXPY STE B1052208
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5779
Practice Address - Country:US
Practice Address - Phone:321-710-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X, 174H00000X
FL22-2016246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688069096Medicaid
FL688069098Medicaid