Healthcare Provider Details

I. General information

NPI: 1225070378
Provider Name (Legal Business Name): SCOTT B SHEREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 E MAIN ST
RIVERHEAD NY
11901-2564
US

IV. Provider business mailing address

937 E MAIN ST
RIVERHEAD NY
11901-2564
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-0777
  • Fax: 631-369-0976
Mailing address:
  • Phone: 631-369-0777
  • Fax: 631-369-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number181162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: