MEDICARE: SHERLY BOURSIQUOT BSW

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	104100000X	Social Worker		FL

General Provider Information

NPI Number	:	1588981930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERLY BOURSIQUOT BSW

Provider Business Mailing Address
First Line	:	2510 SCOTT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-2357
Country	:	US
Telephone Number	:	305-305-3857
Fax Number	:	954-923-3205

Provider Business Practice Location Address
First Line	:	2510 SCOTT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-2357
Country	:	US
Telephone Number	:	305-305-3857
Fax Number	:	954-923-3205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	07/21/2022

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Directions to “ SHERLY BOURSIQUOT BSW” Practice Location

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