Basic Information
| Provider Information | |||||||||
| NPI: | 1871768861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | SHERENE | ||||||||
| MiddleName: | PREMKUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1608 SE 3RD AVE | ||||||||
| Address2: | THIRD FLOOR CBO-PBS | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333162564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548474273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2011 NW 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330604800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547865901 | ||||||||
| FaxNumber: | 9547860129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME 108932 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14JS6 | 01 | FL | FLORIDA BLUE | OTHER | 004522900 | 05 | FL | MEDICAID |