Provider Demographics
NPI:1427081926
Name:SHARIFF, SHIRIN (MSR, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:SHARIFF
Suffix:
Gender:F
Credentials:MSR, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 DEXTER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8660
Mailing Address - Country:US
Mailing Address - Phone:843-367-1975
Mailing Address - Fax:843-573-0089
Practice Address - Street 1:1699 DEXTER LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-8660
Practice Address - Country:US
Practice Address - Phone:843-367-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0657Medicaid