Provider Demographics
NPI:1073706107
Name:SHIENBAUM, JESICA BROMBERG (MD)
Entity Type:Individual
Prefix:
First Name:JESICA
Middle Name:BROMBERG
Last Name:SHIENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 HOLLYWOOD BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6778
Mailing Address - Country:US
Mailing Address - Phone:954-518-4100
Mailing Address - Fax:
Practice Address - Street 1:4100 HOLLYWOOD BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6778
Practice Address - Country:US
Practice Address - Phone:954-518-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190080207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology