Provider Demographics
NPI:1669542445
Name:SANFORD, SHERRI (PA C)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:SANFORD
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:PO BOX 121009
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712
Mailing Address - Country:US
Mailing Address - Phone:352-394-4035
Mailing Address - Fax:352-241-0896
Practice Address - Street 1:1135 LAKE AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-394-4035
Practice Address - Fax:352-241-0896
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2002ZMedicare ID - Type Unspecified
S71652Medicare UPIN