Provider Demographics
NPI:1063828325
Name:SHARIF-ISAACK, SAHARO X
Entity Type:Individual
Prefix:
First Name:SAHARO
Middle Name:
Last Name:SHARIF-ISAACK
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 RIVERVIEW TERRENCE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1170
Mailing Address - Country:US
Mailing Address - Phone:612-205-4707
Mailing Address - Fax:
Practice Address - Street 1:6480 RIVERVIEW TERRENCE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1170
Practice Address - Country:US
Practice Address - Phone:612-205-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEN/AMedicaid
MEN/AMedicare PIN