Provider Demographics
NPI:1043897150
Name:SHERMAN, HIEDI DIANE (BS)
Entity Type:Individual
Prefix:
First Name:HIEDI
Middle Name:DIANE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ROYAL POINCIANA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6667
Mailing Address - Country:US
Mailing Address - Phone:305-668-9000
Mailing Address - Fax:305-668-5095
Practice Address - Street 1:700 S ROYAL POINCIANA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6667
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:305-668-5095
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM102403171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076187700Medicaid