Provider Demographics
NPI:1053149351
Name:SHERROUSE PSYCHIATRY AND WELLNESS
Entity type:Organization
Organization Name:SHERROUSE PSYCHIATRY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-373-8002
Mailing Address - Street 1:1913 STEVERSON RD
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-5601
Mailing Address - Country:US
Mailing Address - Phone:850-373-8002
Mailing Address - Fax:
Practice Address - Street 1:406 S WAUKESHA ST
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2714
Practice Address - Country:US
Practice Address - Phone:850-373-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty