Healthcare Provider Details

I. General information

NPI: 1750549531
Provider Name (Legal Business Name): MAHNOOSH SHARIFI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 EL CAMINO REAL STE 100
ATHERTON CA
94027-3802
US

IV. Provider business mailing address

453 QUARRY RD
PALO ALTO CA
94304-1419
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-6503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC211921
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number054971
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243744
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: