Provider Demographics
NPI:1578579272
Name:SHARIF, SHAHID (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:
Last Name:SHARIF
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:PO BOX 521165
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-1165
Mailing Address - Country:US
Mailing Address - Phone:407-215-5657
Mailing Address - Fax:407-284-1147
Practice Address - Street 1:1906 WINGFIELD DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-7007
Practice Address - Country:US
Practice Address - Phone:407-215-5657
Practice Address - Fax:407-284-1147
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00263398OtherRAILROAD MEDICARE
FL16471OtherBLUE CROSS BLUE SHIELD
FL274581000Medicaid
FLG61488Medicare UPIN
FL16471OtherBLUE CROSS BLUE SHIELD
FLU43972Medicare ID - Type Unspecified