MEDICARE: SHERIDAN DROZDOW HEALTHCARE OF NEVADA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003019266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN DROZDOW HEALTHCARE OF NEVADA PC

Provider Business Mailing Address
First Line	:	1613 NW 136TH AVE
Second Line	:	BUILDING C, SUITE 200
City	:	SUNRISE
State	:	FL
Zip	:	33323-2853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 NORTH DURANGO DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4409
Country	:	US
Telephone Number	:	702-360-9040
Fax Number	:

Authorized Official
Title or Position	:	SOLE SHAREHOLDER, OWNER
Name	:	WILLIAM WEISBERG
Credential	:
Telephone Number	:	954-838-2371

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	03/26/2008

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