Provider Demographics
NPI:1386182913
Name:GEORGY, SHERIF
Entity Type:Individual
Prefix:MR
First Name:SHERIF
Middle Name:
Last Name:GEORGY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2615
Mailing Address - Country:US
Mailing Address - Phone:216-253-7580
Mailing Address - Fax:888-827-4134
Practice Address - Street 1:2333 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4177
Practice Address - Country:US
Practice Address - Phone:216-253-7580
Practice Address - Fax:888-827-4134
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149230Medicaid