Healthcare Provider Details

I. General information

NPI: 1346355849
Provider Name (Legal Business Name): SHARK BIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE #250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

3601 SW 160TH AVE SUITE #250
MIRAMAR FL
33027-6308
US

V. Phone/Fax

Practice location:
  • Phone: 305-866-9951
  • Fax: 877-284-8933
Mailing address:
  • Phone: 305-866-9951
  • Fax: 877-284-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME82517
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: