Provider Demographics
NPI:1104029164
Name:HARAWAY, SHERIF GEORGE (MD)
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:GEORGE
Last Name:HARAWAY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MCDANIEL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7170
Mailing Address - Country:US
Mailing Address - Phone:702-294-0080
Mailing Address - Fax:
Practice Address - Street 1:2031 MCDANIEL ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6312
Practice Address - Country:US
Practice Address - Phone:702-294-0080
Practice Address - Fax:702-965-2220
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV167412084N0400X, 2084P0301X, 2084P2900X
MO20100091522084N0400X
IL036120927208VP0014X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991373041Medicare PIN
ILF400353473Medicare PIN