Provider Demographics
NPI:1063736247
Name:MORAN, SHERRI LYNN (SUPERV)
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:SUPERV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N ARMENIA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2383
Mailing Address - Country:US
Mailing Address - Phone:813-281-5535
Mailing Address - Fax:
Practice Address - Street 1:1401 E FOWLER AVE
Practice Address - Street 2:HEALTHY FAMILIES PROGR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5413
Practice Address - Country:US
Practice Address - Phone:813-558-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator