Provider Demographics
NPI:1215206990
Name:SHERBANY, ADDIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADDIE
Middle Name:
Last Name:SHERBANY
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 1:3200 N OCEAN BLVD
Mailing Address - Street 2:1808
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7152
Mailing Address - Country:US
Mailing Address - Phone:954-494-9900
Mailing Address - Fax:
Practice Address - Street 1:3200 N OCEAN BLVD
Practice Address - Street 2:1808
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7152
Practice Address - Country:US
Practice Address - Phone:954-494-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167675207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology