Healthcare Provider Details

I. General information

NPI: 1891079489
Provider Name (Legal Business Name): SHERLIN LAVIANLIVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERLIN LAVIANLIVI MD

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ELMONT RD
ELMONT NY
11003-4002
US

IV. Provider business mailing address

11 POND VIEW DR
OYSTER BAY NY
11771-2817
US

V. Phone/Fax

Practice location:
  • Phone: 516-328-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number279071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: