Healthcare Provider Details

I. General information

NPI: 1427476563
Provider Name (Legal Business Name): STEPHANIE SORA SHIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 220
MIAMI BEACH FL
33140-2818
US

IV. Provider business mailing address

4302 ALTON RD STE 220
MIAMI BEACH FL
33140-2818
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2090
  • Fax: 305-674-2903
Mailing address:
  • Phone: 305-674-2090
  • Fax: 305-674-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number279163
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME146009
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number279163
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME146009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: