Provider Demographics
NPI:1730480641
Name:SHERWOOD ROY CANTOR MD PA
Entity Type:Organization
Organization Name:SHERWOOD ROY CANTOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERWOOD
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-251-0449
Mailing Address - Street 1:9275 SW 152ND ST
Mailing Address - Street 2:#105
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1701
Mailing Address - Country:US
Mailing Address - Phone:305-251-0449
Mailing Address - Fax:305-255-6169
Practice Address - Street 1:9275 SW 152ND ST
Practice Address - Street 2:#105
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1701
Practice Address - Country:US
Practice Address - Phone:305-251-0449
Practice Address - Fax:305-255-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00176412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056135500Medicaid
FL056135500Medicaid
FL92221Medicare PIN