Provider Demographics
NPI:1043207293
Name:BULLARD, SHERRIE LENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRIE
Middle Name:LENISE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERRIE
Other - Middle Name:LENISE
Other - Last Name:BULLARD LEMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 848098
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-0098
Mailing Address - Country:US
Mailing Address - Phone:954-689-5000
Mailing Address - Fax:
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:877-463-2010
Practice Address - Fax:954-961-8876
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75847207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG56236Medicare UPIN