Provider Demographics
NPI:1295922003
Name:CHERI SURLOFF PH D PSY D PA
Entity type:Organization
Organization Name:CHERI SURLOFF PH D PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:SURLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PH D PSY D PA
Authorized Official - Phone:954-456-7429
Mailing Address - Street 1:501 PALM DR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6533
Mailing Address - Country:US
Mailing Address - Phone:954-456-7429
Mailing Address - Fax:954-456-0949
Practice Address - Street 1:17251 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2209
Practice Address - Country:US
Practice Address - Phone:305-948-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5918103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty