Provider Demographics
NPI:1770678575
Name:STERN, FERNANDO (MD PA)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WASHINGTON ST STE 304
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8258
Mailing Address - Country:US
Mailing Address - Phone:954-961-1500
Mailing Address - Fax:954-961-1500
Practice Address - Street 1:3700 WASHINGTON ST STE 304
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8258
Practice Address - Country:US
Practice Address - Phone:954-961-1500
Practice Address - Fax:954-961-7942
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME264462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057442200Medicaid
FLF18198Medicare UPIN