Provider Demographics
NPI:1134386592
Name:ABDUS-SALAAM, SHARIF ASHANTI (MD)
Entity type:Individual
Prefix:
First Name:SHARIF
Middle Name:ASHANTI
Last Name:ABDUS-SALAAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 WESLEY DR STE 302
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6445
Mailing Address - Country:US
Mailing Address - Phone:901-260-2072
Mailing Address - Fax:901-260-2077
Practice Address - Street 1:3100 N LEE TREVINO DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2116
Practice Address - Country:US
Practice Address - Phone:915-533-7465
Practice Address - Fax:915-534-1185
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45803207X00000X
MS21698207X00000X
TXW0354207X00000X
CAA108853207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108853OtherCALIFORNIA LIC #
TN45803OtherTN MEDICAL LICENSE NUMBER
CACJ428ZMedicare PIN