MEDICARE: DR. NEIL SHERNOFF M.D.

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	207RG0100X	Gastroenterology Physician	13810	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578543336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL SHERNOFF M.D.

Provider Business Mailing Address
First Line	:	6707 N 19TH AVE
Second Line	:	STE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1104
Country	:	US
Telephone Number	:	602-249-4750
Fax Number	:	602-249-4814

Provider Business Practice Location Address
First Line	:	4110 N 108TH AVE STE 105
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5772
Country	:	US
Telephone Number	:	623-772-6999
Fax Number	:	623-772-6444

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/14/2022

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