Provider Demographics
NPI:1366475378
Name:SHAREEF, SHAKEEL R (MD,)
Entity Type:Individual
Prefix:DR
First Name:SHAKEEL
Middle Name:R
Last Name:SHAREEF
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 1:1850 TOWN CENTER PKWY
Mailing Address - Street 2:STE 301
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3300
Mailing Address - Country:US
Mailing Address - Phone:585-233-8449
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:STE 301
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3300
Practice Address - Country:US
Practice Address - Phone:571-353-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194774207W00000X
VA0101256812207W00000X
OH35.135629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02705071Medicaid
NY02705071Medicaid
NYJ400001011Medicare PIN