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General NPI Number Information
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NPI Number | 1902578016
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Entity Type | Individual
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Provider Name | SHIRENE TABARESTANI PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/25/2022
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Provider Practice Location Address
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Address Line | 4300 ALTON RD STE 2110
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2948
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Country | US
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Telephone | 305-674-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 10626 NE 10TH PL
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2104
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Country | US
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Telephone | 786-897-9710
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115112
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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