Provider Demographics
NPI:1790843464
Name:SHAREEF, HUMAYUN (MD DO)
Entity type:Individual
Prefix:DR
First Name:HUMAYUN
Middle Name:
Last Name:SHAREEF
Suffix:
Gender:M
Credentials:MD DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NEBRASKA AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4831
Mailing Address - Country:US
Mailing Address - Phone:772-465-6979
Mailing Address - Fax:772-465-4288
Practice Address - Street 1:2100 NEBRASKA AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:FT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4831
Practice Address - Country:US
Practice Address - Phone:772-465-6979
Practice Address - Fax:772-465-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL058720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263965300Medicaid
FL71097Medicare ID - Type Unspecified
FL263965300Medicaid
FL41V571Medicare PIN