Healthcare Provider Details

I. General information

NPI: 1306147327
Provider Name (Legal Business Name): HUMAYUN SHAREEF MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 FRIST BLVD STE 1
FORT PIERCE FL
34950-4839
US

IV. Provider business mailing address

2401 FRIST BLVD STE 1
FORT PIERCE FL
34950-4839
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-6979
  • Fax: 772-465-4288
Mailing address:
  • Phone: 772-465-6979
  • Fax: 772-465-4288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05870
License Number StateFL

VIII. Authorized Official

Name: HUMAYUN SHAREEF
Title or Position: PHYSICIAN/OWNER
Credential: MD DO
Phone: 772-465-6979