Basic Information
| Provider Information | |||||||||
| NPI: | 1215953641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERIN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 W PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | AVON PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634533121 | ||||||||
| FaxNumber: | 8634522823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 W PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | AVON PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634533121 | ||||||||
| FaxNumber: | 8634522823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME51902 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 274360400 | 05 | FL | MEDICAID |