Provider Demographics
NPI:1558479881
Name:GEISMAR, SHARI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:
Last Name:GEISMAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S ALAFAYA TRAIL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-275-5700
Mailing Address - Fax:407-381-5802
Practice Address - Street 1:1537 S ALAFAYA TRAIL
Practice Address - Street 2:SUITE 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:407-275-5700
Practice Address - Fax:407-381-5802
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7234208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57477OtherBCBS PROVIDER NUMBER