Healthcare Provider Details

I. General information

NPI: 1114852019
Provider Name (Legal Business Name): MARINA HISHAM SHAFIK ABOELSAAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW 79TH AVE
DORAL FL
33122-1174
US

IV. Provider business mailing address

1444 NW 14TH AVE APT 1506
MIAMI FL
33125-1694
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-1010
  • Fax:
Mailing address:
  • Phone: 786-893-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPSI48596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: