Healthcare Provider Details

I. General information

NPI: 1295969624
Provider Name (Legal Business Name): SHEREENE IDRISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 06/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IDRISS DERMATOLOGY 80 W 40TH ST, 3RD FLOOR
NEW YORK NY
10018-2682
US

IV. Provider business mailing address

80 W 40TH ST FLOOR 3
NEW YORK NY
10018-2682
US

V. Phone/Fax

Practice location:
  • Phone: 212-612-1520
  • Fax: 332-216-3520
Mailing address:
  • Phone: 212-612-1520
  • Fax: 332-216-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number269568-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number269568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: