Provider Demographics
NPI:1982038246
Name:MUBARAK, SHERIN NAZME (PA)
Entity Type:Individual
Prefix:
First Name:SHERIN
Middle Name:NAZME
Last Name:MUBARAK
Suffix:
Gender:F
Credentials:PA
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 948479
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-8479
Mailing Address - Country:US
Mailing Address - Phone:407-730-2370
Mailing Address - Fax:407-730-8971
Practice Address - Street 1:1277 N SEMORAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3569
Practice Address - Country:US
Practice Address - Phone:407-730-8970
Practice Address - Fax:407-730-8971
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant