Provider Demographics
NPI:1366001224
Name:SHAH SHAREEF, D.O., LLC
Entity type:Organization
Organization Name:SHAH SHAREEF, D.O., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHJAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-240-9190
Mailing Address - Street 1:5741 BEE RIDGE RD STE 570
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5080
Mailing Address - Country:US
Mailing Address - Phone:941-203-8757
Mailing Address - Fax:941-552-8647
Practice Address - Street 1:5741 BEE RIDGE RD STE 570
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5080
Practice Address - Country:US
Practice Address - Phone:941-203-8757
Practice Address - Fax:941-552-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15795OtherDOH