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General NPI Number Information
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NPI Number | 1255644118
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Entity Type | Individual
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Provider Name | MOSTAFA S ASSADALLA SHERAZY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2999 NE 191ST ST
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City | AVENTURA
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State | FL
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Zip | 33180-3123
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Country | US
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Telephone | 786-981-0640
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Fax | 305-677-8067
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Provider Business Mailing Address
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Address Line | 2999 NE 191ST ST
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City | AVENTURA
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State | FL
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Zip | 33180-3123
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Country | US
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Telephone | 786-981-0640
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Fax | 305-677-8067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | IMLC.MD.61164093
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MT196759
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License Number State | PA
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