Healthcare Provider Details

I. General information

NPI: 1881958452
Provider Name (Legal Business Name): COLEY SHERIFF ROSENFELD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N STE 203
BOCA RATON FL
33428-2236
US

IV. Provider business mailing address

9970 CENTRAL PARK BLVD N STE 203
BOCA RATON FL
33428-2236
US

V. Phone/Fax

Practice location:
  • Phone: 561-487-1616
  • Fax: 561-487-1619
Mailing address:
  • Phone: 561-487-1616
  • Fax: 561-487-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012017457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: