Provider Demographics
NPI:1114707049
Name:SHARIF, OMAR C
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:C
Last Name:SHARIF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 SWAN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4376
Mailing Address - Country:US
Mailing Address - Phone:863-348-1188
Mailing Address - Fax:
Practice Address - Street 1:1452 SWAN LAKE CIR
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4376
Practice Address - Country:US
Practice Address - Phone:863-348-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS610643614430172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver