Healthcare Provider Details

I. General information

NPI: 1144723958
Provider Name (Legal Business Name): STEVENSON BRISSON CHERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W HALLANDALE BEACH BLVD
WEST PARK FL
33023-5244
US

IV. Provider business mailing address

5010 HOLLYWOOD BLVD # 5012
HOLLYWOOD FL
33021-6557
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-3939
  • Fax: 954-966-5959
Mailing address:
  • Phone: 954-967-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME143611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: