Healthcare Provider Details

I. General information

NPI: 1932407376
Provider Name (Legal Business Name): FLORIDA ROBOTIC AND MINIMALLY INVASIVE UROGYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
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 TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. AMIR SHARIATI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-479-7030