MEDICARE: SIDNEY MARC CHERELUS M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013259761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY MARC CHERELUS M.S.

Provider Business Mailing Address
First Line	:	1351 NW 133RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33167-1722
Country	:	US
Telephone Number	:	786-623-9271
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 S PERIMETER RD
Second Line	:	SUITE 120
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-7122
Country	:	US
Telephone Number	:	954-958-0988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/20/2013

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