Provider Demographics
NPI:1740444736
Name:LIEBERMAN, ALEXANDRA CHEYENNE (DO)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHEYENNE
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NW 15TH ST STE 215A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1342
Mailing Address - Country:US
Mailing Address - Phone:561-392-7704
Mailing Address - Fax:561-392-8103
Practice Address - Street 1:1050 NW 15TH ST STE 215A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1342
Practice Address - Country:US
Practice Address - Phone:561-392-7704
Practice Address - Fax:561-392-8103
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.002487390200000X
FLOS11498207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program