Healthcare Provider Details

I. General information

NPI: 1790843464
Provider Name (Legal Business Name): HUMAYUN SHAREEF MD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NEBRASKA AVENUE SUITE 111
FT PIERCE FL
34950-4831
US

IV. Provider business mailing address

2100 NEBRASKA AVENUE SUITE 111
FT PIERCE FL
34950-4831
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 Number058720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: