Provider Demographics
NPI:1285380808
Name:PEACOCK, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 W 23RD ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1830
Mailing Address - Country:US
Mailing Address - Phone:850-818-0095
Mailing Address - Fax:
Practice Address - Street 1:3208 W 23RD ST UNIT 4
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1830
Practice Address - Country:US
Practice Address - Phone:850-818-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician