Healthcare Provider Details

I. General information

NPI: 1457360109
Provider Name (Legal Business Name): SANDY LIEBERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 KANE CONCOURSE
BAY HARBOR ISLANDS FL
33154-2012
US

IV. Provider business mailing address

1145 KANE CONCOURSE
BAY HARBOR ISLANDS FL
33154-2012
US

V. Phone/Fax

Practice location:
  • Phone: 305-865-5439
  • Fax: 305-866-5366
Mailing address:
  • Phone: 305-865-5439
  • Fax: 305-866-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME69536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: