Provider Demographics
NPI:1114114311
Name:ELLIS, SHERRY B (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:B
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3466
Mailing Address - Country:US
Mailing Address - Phone:561-241-3917
Mailing Address - Fax:561-241-8922
Practice Address - Street 1:6646 ATLANTIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1627
Practice Address - Country:US
Practice Address - Phone:561-638-9533
Practice Address - Fax:561-638-7760
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME57250207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255747900Medicaid
FLP00600420OtherRR MEDICARE
FL10314VMedicare PIN