Healthcare Provider Details

I. General information

NPI: 1790919371
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

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

7821 SW 137TH CT
MIAMI FL
33183-3112
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-1960
  • Fax:
Mailing address:
  • Phone: 305-763-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberRN9200892
License Number StateFL

VIII. Authorized Official

Name: MS. ELLY MIEDES
Title or Position: CRNA
Credential:
Phone: 305-763-1330