Healthcare Provider Details

I. General information

NPI: 1629427430
Provider Name (Legal Business Name): JALAL SHARIAT MOHARRERI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 MCMULLEN BOOTH RD
SAFETY HARBOR FL
34695-6607
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-532-0002
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS15896
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS15896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: