Healthcare Provider Details

I. General information

NPI: 1639673627
Provider Name (Legal Business Name): SHERIF BADRA MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 08/02/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 S FALKENBURG RD STE 201
RIVERVIEW FL
33578-2594
US

IV. Provider business mailing address

3140 S FALKENBURG RD STE 201
RIVERVIEW FL
33578-2594
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-0030
  • Fax:
Mailing address:
  • Phone: 813-910-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME154237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: