Provider Demographics
NPI:1700524592
Name:SESLER- THOMAS, SHARI REGINA
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:REGINA
Last Name:SESLER- THOMAS
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 1:15870 NW 44TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-3299
Mailing Address - Country:US
Mailing Address - Phone:352-875-3261
Mailing Address - Fax:
Practice Address - Street 1:15870 NW 44TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686-3299
Practice Address - Country:US
Practice Address - Phone:352-875-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities