Provider Demographics
NPI:1235752395
Name:EBADIAN, SHERRY SHARAREH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:SHARAREH
Last Name:EBADIAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3413
Mailing Address - Country:US
Mailing Address - Phone:954-338-0283
Mailing Address - Fax:
Practice Address - Street 1:801 S UNIVERSITY DR STE C136
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3366
Practice Address - Country:US
Practice Address - Phone:954-693-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant