Healthcare Provider Details

I. General information

NPI: 1689238347
Provider Name (Legal Business Name): SHERRY DEMIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7322
US

IV. Provider business mailing address

PO BOX 945921
ATLANTA GA
30394-5921
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-6400
  • Fax: 386-424-6422
Mailing address:
  • Phone:
  • Fax: 386-672-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME157879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: