MEDICARE: DR. SHAKEEL R SHAREEF M.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	194774	NY
2	207W00000X	Ophthalmology Physician	0101256812	VA
3	207W00000X	Ophthalmology Physician	35.135629	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366475378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAKEEL R SHAREEF M.D,

Provider Business Mailing Address
First Line	:	1850 TOWN CENTER PKWY
Second Line	:	STE 301
City	:	RESTON
State	:	VA
Zip	:	20190-3300
Country	:	US
Telephone Number	:	585-233-8449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 TOWN CENTER PKWY
Second Line	:	STE 301
City	:	RESTON
State	:	VA
Zip	:	20190-3300
Country	:	US
Telephone Number	:	571-353-1903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/19/2021

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