Provider Demographics
NPI:1891079489
Name:LAVIANLIVI, SHERLIN (MD)
Entity type:Individual
Prefix:
First Name:SHERLIN
Middle Name:
Last Name:LAVIANLIVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERLIN
Other - Middle Name:
Other - Last Name:LAVIANLIVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4002
Practice Address - Country:US
Practice Address - Phone:516-328-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2790712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology