Provider Demographics
NPI:1669718839
Name:GEORGE, SHERIN MARY (PA-C)
Entity type:Individual
Prefix:
First Name:SHERIN
Middle Name:MARY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12391 SUMMER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2044
Mailing Address - Country:US
Mailing Address - Phone:630-785-0255
Mailing Address - Fax:
Practice Address - Street 1:1180 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1409
Practice Address - Country:US
Practice Address - Phone:888-822-8436
Practice Address - Fax:203-590-8644
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL85-004586363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1669718839OtherNPI