Provider Demographics
NPI:1437352010
Name:SCHENKER, MICHAEL ASHLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ASHLEY
Last Name:SCHENKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NW 152ND LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1844
Mailing Address - Country:US
Mailing Address - Phone:954-547-3086
Mailing Address - Fax:954-827-0711
Practice Address - Street 1:1000 N HIATUS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3097
Practice Address - Country:US
Practice Address - Phone:954-547-3086
Practice Address - Fax:954-827-0711
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5906103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302125OtherAVMED PROVIDER NUMBER
FL9413593OtherPHCS PROVIDER NUMBER