Healthcare Provider Details

I. General information

NPI: 1386842136
Provider Name (Legal Business Name): AMIR SHARIATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD SUITE 207
COCONUT CREEK FL
33073-4395
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD SUITE 207
COCONUT CREEK FL
33073-4395
US

V. Phone/Fax

Practice location:
  • Phone: 561-479-7030
  • Fax: 561-483-4489
Mailing address:
  • Phone: 561-479-7030
  • Fax: 561-483-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number106332
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME106332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: