Healthcare Provider Details

I. General information

NPI: 1093917478
Provider Name (Legal Business Name): SHAHROKHF SHARIAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE BOX 27
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1233 YORK AVE 10I
NEW YORK NY
10065-6306
US

V. Phone/Fax

Practice location:
  • Phone: 469-363-8500
  • Fax:
Mailing address:
  • Phone: 469-363-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: