Provider Demographics
NPI:1255972519
Name:SHAW, ZARISH HAROON
Entity type:Individual
Prefix:
First Name:ZARISH
Middle Name:HAROON
Last Name:SHAW
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 1:2705 SW 119TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5697
Mailing Address - Country:US
Mailing Address - Phone:954-732-5148
Mailing Address - Fax:
Practice Address - Street 1:2705 SW 119TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5697
Practice Address - Country:US
Practice Address - Phone:954-732-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty