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Organization

SPORTS MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRYSTAL A. HERRERA (CREDENTIALING COORDINATOR)
(305) 218-6965
Entity
Organization

Contact information

Practice address
220 SW 84TH AVE STE 102, PLANTATION, FL 33324-2729
(954) 720-1530
(954) 720-6540
Mailing address
220 SW 84TH AVE STE 102, PLANTATION, FL 33324-2729
(954) 349-2345
(954) 641-1086

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
207XS0106X
Orthopaedic Hand Surgery Physician
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
208100000X
Physical Medicine & Rehabilitation Physician
363A00000X
Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002398700
MEDICAID - ALEXANDER J. BERTOT, M.D.
FL
01
002462700
MEDICAID - DAVID SHENASSA, M.D.
FL
01
002602400
MEDICAID - ERIC D. BRONSON, PA-C
FL
01
002603000
MEDICAID - PAUL R. BUCHANAN, PA-C
FL
01
002615000
MEDICAID - ALFRED A. DESIMONE, M.D.
FL
05
002876700
FL
01
108857600
MEDICAID - SYDNEE R. BRIN, PA-C
FL
01
118651300
MEDICAID - JESSE T. CROSNO, PA-C
FL
01
119205700
MEDICAID - PEDRO A. RICART HOFFIZ, M.D.
FL
01
1558022426
MEDICAID - HANNA E. HEMMATI, PA-C
FL
Enumeration date
01/26/2006
Last updated
09/24/2024
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