Provider Demographics
NPI:1679008205
Name:MARCEUS, SHERLY (RBT)
Entity type:Individual
Prefix:
First Name:SHERLY
Middle Name:
Last Name:MARCEUS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5764 FOLKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-9404
Mailing Address - Country:US
Mailing Address - Phone:407-289-7719
Mailing Address - Fax:
Practice Address - Street 1:5764 FOLKSTONE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-9404
Practice Address - Country:US
Practice Address - Phone:407-289-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019831900Medicare PIN