Provider Demographics
NPI:1073350187
Name:SHARIFI, KIERSTIN
Entity type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:
Last Name:SHARIFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 ILLINOIS ST STE 350
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3009
Mailing Address - Country:US
Mailing Address - Phone:317-796-6895
Mailing Address - Fax:
Practice Address - Street 1:11725 ILLINOIS ST STE 350
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3009
Practice Address - Country:US
Practice Address - Phone:317-688-5058
Practice Address - Fax:317-968-1144
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist