Healthcare Provider Details

I. General information

NPI: 1114114311
Provider Name (Legal Business Name): SHERRY B. ELLIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6646 ATLANTIC AVE STE 100
DELRAY BEACH FL
33446-1627
US

IV. Provider business mailing address

5801 NW 23RD AVE
BOCA RATON FL
33496-3466
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-9533
  • Fax: 561-638-7760
Mailing address:
  • Phone: 561-241-3917
  • Fax: 561-241-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME57250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: