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General NPI Number Information
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NPI Number | 1518841527
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Entity Type | Organization
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Legal Business Name | EHSAN Y. SHARAF-ELDEEN DMD, MD, FACS, P.A.
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 940 S HARBOR CITY BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-1909
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Country | US
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Telephone | 352-246-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 940 S HARBOR CITY BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-1909
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Country | US
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Telephone | 352-246-3131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | EHSAN Y SHARAF-ELDEEN
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Credential | MD, DMD
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Telephone | 352-246-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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