Provider Demographics
NPI:1568912772
Name:SHARIFI SABER, SADRA (MD)
Entity Type:Individual
Prefix:MR
First Name:SADRA
Middle Name:
Last Name:SHARIFI SABER
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 1:1111 AMSTERDAM AVENUE, CLARK BUILDING, 10 FL SUITE 007
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-523-2154
Mailing Address - Fax:212-523-5402
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:CLARK BUILDING 10 FL, SUITE 007
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-523-2154
Practice Address - Fax:212-523-5402
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285611390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program