Provider Demographics
NPI:1043602584
Name:SHEREZA N. ABDOOL D.O. P.C.
Entity Type:Organization
Organization Name:SHEREZA N. ABDOOL D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOOL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-752-4203
Mailing Address - Street 1:1501 S PINELLAS AVE
Mailing Address - Street 2:SUITE P
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1955
Mailing Address - Country:US
Mailing Address - Phone:727-940-5278
Mailing Address - Fax:813-464-3113
Practice Address - Street 1:1501 S PINELLAS AVE
Practice Address - Street 2:SUITE P
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-940-5278
Practice Address - Fax:813-464-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 11562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty