Provider Demographics
NPI:1750652194
Name:SAULTER, SHEREE L (MA)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:L
Last Name:SAULTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 ROBINHOOD LANE SOUTH
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2340
Mailing Address - Country:US
Mailing Address - Phone:863-221-2785
Mailing Address - Fax:
Practice Address - Street 1:5001 S FLORIDA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2776
Practice Address - Country:US
Practice Address - Phone:863-221-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8077101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)