Provider Demographics
NPI:1871768861
Name:ALEXANDER, SHERENE PREMKUMAR (MD)
Entity type:Individual
Prefix:
First Name:SHERENE
Middle Name:PREMKUMAR
Last Name:ALEXANDER
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 1:1608 SE 3RD AVE
Mailing Address - Street 2:THIRD FLOOR CBO-PBS
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-847-4273
Mailing Address - Fax:
Practice Address - Street 1:2011 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4800
Practice Address - Country:US
Practice Address - Phone:954-786-5901
Practice Address - Fax:954-786-0129
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 108932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14JS6OtherFLORIDA BLUE
FL004522900Medicaid
FL004522900Medicaid