Healthcare Provider Details

I. General information

NPI: 1326272907
Provider Name (Legal Business Name): SHERIDAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14209 SW 54TH ST
MIAMI FL
33175-5810
US

IV. Provider business mailing address

14209 SW 54TH ST
MIAMI FL
33175-5810
US

V. Phone/Fax

Practice location:
  • Phone: 305-519-6553
  • Fax:
Mailing address:
  • Phone: 305-519-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberRN9233902
License Number StateFL

VIII. Authorized Official

Name: MS. ELIZABETH LOPEZ
Title or Position: CRNA
Credential:
Phone: 305-519-6553