Healthcare Provider Details

I. General information

NPI: 1740885821
Provider Name (Legal Business Name): SHARDE PEREIRA CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29253 US HIGHWAY 19 N
CLEARWATER FL
33761-2102
US

IV. Provider business mailing address

7324 SOUTHWEST FWY STE 1550
HOUSTON TX
77074-2053
US

V. Phone/Fax

Practice location:
  • Phone: 727-313-4764
  • Fax:
Mailing address:
  • Phone: 713-779-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number120554
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: