Healthcare Provider Details

I. General information

NPI: 1053808949
Provider Name (Legal Business Name): SEHRISH VIQAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

609 RUST WAY
STOCKBRIDGE GA
30281-7649
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4106
  • Fax: 727-767-8804
Mailing address:
  • Phone: 229-326-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: