Healthcare Provider Details

I. General information

NPI: 1457855991
Provider Name (Legal Business Name): SHERWIN ZACHARIAH THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W. OAK ST., STE 201
KISSIMMEE FL
34741
US

IV. Provider business mailing address

51577 MERRY LN
SHELBY TOWNSHIP MI
48316-3860
US

V. Phone/Fax

Practice location:
  • Phone: 321-697-1730
  • Fax: 407-518-3923
Mailing address:
  • Phone: 586-726-9374
  • Fax: 407-518-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME149747
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: