Healthcare Provider Details

I. General information

NPI: 1871768861
Provider Name (Legal Business Name): SHERENE PREMKUMAR ALEXANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 NW 3RD AVE
POMPANO BEACH FL
33060-4800
US

IV. Provider business mailing address

1608 SE 3RD AVE THIRD FLOOR CBO-PBS
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-5901
  • Fax: 954-786-0129
Mailing address:
  • Phone: 954-847-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 108932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: