Healthcare Provider Details

I. General information

NPI: 1689930653
Provider Name (Legal Business Name): SHERIDAN CHILDREN'S HEALTHCARE SERVICES OF TENNESSEE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 HUMPHREYS BLVD
MEMPHIS TN
38120-2373
US

IV. Provider business mailing address

PO BOX 452005
SUNRISE FL
33345-2005
US

V. Phone/Fax

Practice location:
  • Phone: 901-227-2431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M. RICHARD AUERBACH
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371