Healthcare Provider Details

I. General information

NPI: 1386623221
Provider Name (Legal Business Name): SHERIL L BURDINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10911 S EASTERN AVE ST ROSE PEDIATRICS
HENDERSON NV
89052
US

IV. Provider business mailing address

PO BOX 50105 ST ROSE PEDIATRICS
HENDERSON NV
89016-0105
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-8556
  • Fax: 702-564-4485
Mailing address:
  • Phone: 702-564-8556
  • Fax: 702-564-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11578
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: