Healthcare Provider Details

I. General information

NPI: 1336033935
Provider Name (Legal Business Name): SHAKIRA BRIANA IMANI SALEEM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W CALL ST
TALLAHASSEE FL
32304-3556
US

IV. Provider business mailing address

1600 36TH ST STE B
VERO BEACH FL
32960-4875
US

V. Phone/Fax

Practice location:
  • Phone: 772-464-0034
  • Fax:
Mailing address:
  • Phone: 772-567-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9121251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: