Provider Demographics
NPI:1760411078
Name:SHERRY, RONALD EUGENE
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:SHERRY
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 1:948 FALLING WATER RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3554
Mailing Address - Country:US
Mailing Address - Phone:954-389-7787
Mailing Address - Fax:
Practice Address - Street 1:948 FALLING WATER RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3554
Practice Address - Country:US
Practice Address - Phone:954-389-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9100753363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ48704Medicare UPIN