Individual provider Active NPI

Shreeja Kurup

  • Family Nurse Practitioner
  • Pembroke Pines, FL
National Provider Identifier
1629746102
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11010026 Issued in FL
Practice address
19236 NW 14TH St
Pembroke Pines, FL 33029-4508
Phone
(786) 277-7738
NPI assigned
Aug 31, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 11010026 FL
Family Nurse Practitioner 363LF0000X 11010026 FL Primary

Addresses

Primary practice location

19236 NW 14TH St
Pembroke Pines, FL 33029-4508

Mailing address

19236 NW 14TH St
Pembroke Pines, FL 33029-4508
Phone (786) 277-7738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230127001994 FL Practitioner - Nurse Practitioner 3678944758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sheridan Healthcorp IncGroup PAC ID 3173429693, 956 clinicians

Practice addresses (Care Compare)

3501 Johnson St
Hollywood, FL 33021-5421
Phone (954) 265-5339

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11010026FLMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp, Inc. CurrentSince Jan 1, 2023 Accepting new patients
Sheridan Healthcorp Inc Current Accepting new patients
Sheridan Healthcorp Inc CurrentSince Jan 1, 2023 Accepting new patients

Locations

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

Organizations & group practices 3

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": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1629746102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19236 NW 14TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330294508",
            "telephone_number": "786-277-7738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19236 NW 14TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330294508",
            "telephone_number": "786-277-7738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURUP",
        "first_name": "SHREEJA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "11010026",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11010026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.