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General NPI Number Information
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NPI Number | 1730488982
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Entity Type | Organization
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Legal Business Name | SHAREEF JANDALI PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 03/26/2011
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 5520 PARK AVE SUITE WP-2-300
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City | TRUMBULL
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State | CT
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Zip | 06611-3463
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Country | US
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Telephone | 203-374-0310
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Fax | 203-374-0314
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Provider Business Mailing Address
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Address Line | 5520 PARK AVE SUITE WP-2-300
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City | TRUMBULL
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State | CT
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Zip | 06611-3463
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Country | US
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Telephone | 203-374-0310
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Fax | 203-374-0314
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAREEF JANDALI
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Credential | MD
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Telephone | 203-374-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 049538
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License Number State | CT
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