Healthcare Provider Details

I. General information

NPI: 1578884607
Provider Name (Legal Business Name): SHELDON JERRY GILLINOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CONGRESS AVE
DELRAY BEACH FL
33445-4616
US

IV. Provider business mailing address

19586 BAY VIEW ROAD
BOCA RATON FL
33434-5101
US

V. Phone/Fax

Practice location:
  • Phone: 561-274-3100
  • Fax: 561-837-5332
Mailing address:
  • Phone: 561-852-2306
  • Fax: 561-852-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME105949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: