Healthcare Provider Details

I. General information

NPI: 1669560751
Provider Name (Legal Business Name): SHEREEN IBRAHIM OLOUFA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/16/2020
Certification Date: 05/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 MAGUIRE RD
OCOEE FL
34761-4797
US

IV. Provider business mailing address

2711 MAGUIRE RD
OCOEE FL
34761-4797
US

V. Phone/Fax

Practice location:
  • Phone: 407-777-1774
  • Fax: 407-979-8040
Mailing address:
  • Phone: 407-777-1774
  • Fax: 407-979-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME 84000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: