Healthcare Provider Details

I. General information

NPI: 1750563128
Provider Name (Legal Business Name): SHERIF M ABDALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

11302 N VIA SAN TOMA DR
FRESNO CA
93730-9740
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-1600
  • Fax:
Mailing address:
  • Phone: 323-359-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA 101952
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA-101952
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA-101952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: