Healthcare Provider Details

I. General information

NPI: 1437839990
Provider Name (Legal Business Name): SHERIF SHEHATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

50 MEDICAL PARK DR E
BIRMINGHAM AL
35235-3401
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax: 631-376-3420
Mailing address:
  • Phone:
  • Fax: 205-838-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number53905
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: