Individual provider Active NPI

Sherry Shariatmadar

  • Anatomic Pathology & Clinical Pathology Physician
  • Miami, FL
National Provider Identifier
1609880665
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
25MA12024000 Issued in NJ
Practice address
1611 NW 12TH Ave
Box 016960 M851
Miami, FL 33136-1005
Phone
(305) 585-6303
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 25MA12024000 NJ Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X ME73969 FL

Addresses

Primary practice location

1611 NW 12TH Ave
Box 016960 M851
Miami, FL 33136-1005

Mailing address

1611 NW 12TH Ave
Box 016960 M851
Miami, FL 33136-1005
Phone (305) 585-6303

Other identifiers 1

IdentifierTypeStateIssuer
2527952-00MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231205002050 NJ Practitioner - Pathology 4880663251 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA12024000NJMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Feb 15, 2017 Accepting new patients
University Physician Associates of New Jersey Inc Anatomic Pathology & Clinical Pathology CurrentSince Nov 1, 2023 Accepting new patients
Nassau Health Care Corporation CurrentSince Aug 6, 2017 Accepting new patients
North Shore-Lij Medical PC CurrentSince Feb 15, 2017 Accepting new patients
Nassau Health Care Corporation CurrentSince Aug 6, 2017 Accepting new patients
University Physician Associates of New Jersey Inc CurrentSince Nov 1, 2023 Accepting new patients
Nassau Health Care Corporation Current Accepting new patients

Locations

150 Bergen St
Newark, NJ 07103
Phone (973) 972-6056

30 Bergen St
#12
Newark, NJ 07107
Phone (973) 972-0037

2201 Hempstead Tpke
Rm 2448
East Meadow, NY 11554
Phone (516) 572-1234

2201 Hempstead Tpke
East Meadow, NY 11554
Phone (516) 486-6862

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Plandome, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1609880665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 NW 12TH AVE",
            "address_2": "BOX 016960 M851",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361005",
            "telephone_number": "305-585-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 NW 12TH AVE",
            "address_2": "BOX 016960 M851",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361005",
            "telephone_number": "305-585-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARIATMADAR",
        "first_name": "SHERRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MA12024000",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME73969",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2527952-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.