Provider Demographics
NPI:1710477963
Name:ALSHAREEF, SANAD WASMI (DO)
Entity Type:Individual
Prefix:
First Name:SANAD
Middle Name:WASMI
Last Name:ALSHAREEF
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 1:280 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8835
Mailing Address - Country:US
Mailing Address - Phone:904-420-7903
Mailing Address - Fax:904-663-0273
Practice Address - Street 1:280 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8835
Practice Address - Country:US
Practice Address - Phone:904-420-7903
Practice Address - Fax:904-663-0273
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty