Provider Demographics
NPI:1912961616
Name:SHERER, MIRA (DO)
Entity Type:Individual
Prefix:DR
First Name:MIRA
Middle Name:
Last Name:SHERER
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 1:47 GAYLORD DR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6711
Mailing Address - Country:US
Mailing Address - Phone:718-331-1442
Mailing Address - Fax:718-680-4473
Practice Address - Street 1:8712 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5110
Practice Address - Country:US
Practice Address - Phone:718-680-1600
Practice Address - Fax:718-680-4473
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216785-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-3552139Other1199 NBF
NY3099497OtherGHI
NYP2749118OtherOXFORD
NY11-3552139OtherMAGNACARE
NY11202375OtherMULTIPLAN
NY4C4368OtherHEALTH NET
NY010116302OtherAMERICHOICE
NY1424985OtherCIGNA
NY02186932Medicaid
NY2167851OtherHIP
NY128720301OtherHEALTH PLUS
NY458N61OtherEMPIRE BC/BS
NY2167851OtherHIP
NY3099497OtherGHI