Provider Demographics
NPI:1215250246
Name:SHARIFI, MAHIN
Entity type:Individual
Prefix:
First Name:MAHIN
Middle Name:
Last Name:SHARIFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 W HILLSBOROUGH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1059
Mailing Address - Country:US
Mailing Address - Phone:813-872-4492
Mailing Address - Fax:
Practice Address - Street 1:2333 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1052
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:813-870-1502
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant