MEDICARE: STERLING MEDICAL

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	261Q00000X	Clinic/Center	PA9101194	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9101194	OTHER	FL	LICENSE
2	0041421	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1649212226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STERLING MEDICAL

Provider Business Mailing Address
First Line	:	2181 NW 139TH TER
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2838
Country	:	US
Telephone Number	:	954-442-1619
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4048
Country	:	US
Telephone Number	:	954-575-4940
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MRS. YOLANDE THOMAS-ELLIS
Credential	:	PA
Telephone Number	:	954-575-4940

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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Directions to “STERLING MEDICAL ” Practice Location

Language	Start Address	Practice Location

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