Provider Demographics
NPI:1699087999
Name:SALEH, SHERIF A (MD)
Entity type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:A
Last Name:SALEH
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 1:291 S LAMBERT RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3559
Mailing Address - Country:US
Mailing Address - Phone:203-553-9537
Mailing Address - Fax:203-553-9540
Practice Address - Street 1:291 S LAMBERT RD STE 5
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3559
Practice Address - Country:US
Practice Address - Phone:203-553-9537
Practice Address - Fax:203-553-9540
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56584208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008075039Medicaid