=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497827000
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABRIYA B ISHOOF MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8525 SW 92ND ST STE D16
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-401-6562
-----------------------------------------------------
Fax | 786-212-1406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8525 SW 92 STREET SUITE D-16
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-401-6562
-----------------------------------------------------
Fax | 786-212-1406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME98193
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------