Healthcare Provider Details

I. General information

NPI: 1174577498
Provider Name (Legal Business Name): SHERYL OLIVIA THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST SUITE 102
TEQUESTA FL
33469-4709
US

IV. Provider business mailing address

1 MAIN ST SUITE 102
TEQUESTA FL
33469-4709
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-4464
  • Fax: 561-747-5598
Mailing address:
  • Phone: 561-747-4464
  • Fax: 561-747-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME75642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: