Provider Demographics
NPI:1003019266
Name:SHERIDAN DROZDOW HEALTHCARE OF NEVADA PC
Entity Type:Organization
Organization Name:SHERIDAN DROZDOW HEALTHCARE OF NEVADA PC
Other - Org Name:SHERIDAN HEALTHCARE OF NEVADA PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE SHAREHOLDER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-838-2371
Mailing Address - Street 1:1613 NW 136TH AVE
Mailing Address - Street 2:BUILDING C, SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6900 NORTH DURANGO DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4409
Practice Address - Country:US
Practice Address - Phone:702-360-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003019266 (GROUP #)Medicaid