Basic Information
| Provider Information | |||||||||
| NPI: | 1285701060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATEROUS | ||||||||
| FirstName: | SHEREE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 LAKE WORTH RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334634727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619687968 | ||||||||
| FaxNumber: | 5614328935 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 JFK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614328935 | ||||||||
| FaxNumber: | 5614328937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9105530 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.