Provider Demographics
NPI:1568647196
Name:LEVINE, SHERRY LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LEIGH
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:LEIGH
Other - Last Name:FISHKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:18501 PINES BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1420
Practice Address - Country:US
Practice Address - Phone:954-237-2505
Practice Address - Fax:954-237-2510
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-130813207Y00000X
FLME120907207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015488000Medicaid
FL015488000Medicaid