Provider Demographics
NPI:1659485290
Name:SACK, FLEUR SHIRNA (MD)
Entity Type:Individual
Prefix:DR
First Name:FLEUR
Middle Name:SHIRNA
Last Name:SACK
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 1:7554 SW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3135
Mailing Address - Country:US
Mailing Address - Phone:786-512-3891
Mailing Address - Fax:
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2212
Practice Address - Country:US
Practice Address - Phone:786-871-7188
Practice Address - Fax:786-718-1417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63811Medicare UPIN