Provider Demographics
NPI:1962147306
Name:SHARAF, AHMED MOUSTAFA (DPT)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOUSTAFA
Last Name:SHARAF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EAST ST N
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2400
Mailing Address - Country:US
Mailing Address - Phone:860-726-8163
Mailing Address - Fax:
Practice Address - Street 1:50 EAST ST N
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2400
Practice Address - Country:US
Practice Address - Phone:860-726-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist