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General NPI Number Information
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NPI Number | 1467053223
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Entity Type | Organization
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Legal Business Name | SHERIDAN-PINES MRI, LLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 6860 SW 195TH AVE
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City | FT LAUDERDALE
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State | FL
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Zip | 33332-1656
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Country | US
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Telephone | 954-369-4860
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Fax | 954-369-4865
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Provider Business Mailing Address
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Address Line | 6860 SW 195TH AVE
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City | FT LAUDERDALE
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State | FL
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Zip | 33332-1656
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Country | US
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Telephone | 954-369-4860
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Fax | 954-369-4865
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JASON DAVIS
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Credential |
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Telephone | 954-797-6744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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