Healthcare Provider Details

I. General information

NPI: 1265415772
Provider Name (Legal Business Name): SHERIDAN CHILDREN HEALTHCARE SERVICES OF PENNSYLVANIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY #200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

PO BOX 841107
PEMBROKE PINES FL
33084-3107
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GILBERT DROZDOW
Title or Position: SENIOR VICE PRESIDENT
Credential: M.D
Phone: 954-838-2371