Provider Demographics
NPI:1174577498
Name:THOMPSON, SHERYL OLIVIA (MD)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:OLIVIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-4709
Mailing Address - Country:US
Mailing Address - Phone:561-747-4464
Mailing Address - Fax:561-747-5598
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-4709
Practice Address - Country:US
Practice Address - Phone:561-747-4464
Practice Address - Fax:561-747-5598
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75642207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43513XMedicare ID - Type Unspecified
FLG60880Medicare UPIN