Healthcare Provider Details

I. General information

NPI: 1578543336
Provider Name (Legal Business Name): NEIL SHERNOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 N 108TH AVE STE 105
PHOENIX AZ
85037-5772
US

IV. Provider business mailing address

6707 N 19TH AVE STE 200
PHOENIX AZ
85015-1104
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-6999
  • Fax: 623-772-6444
Mailing address:
  • Phone: 602-249-4750
  • Fax: 602-249-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number13810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: