NPIMap

Organization Active NPI

Shareef Jandali Plastic Surgery LLC

  • Plastic and Reconstructive Surgery Physician
  • Trumbull, CT
National Provider Identifier
1730488982
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
049538 Issued in CT
Legal business name
SHAREEF JANDALI PLASTIC SURGERY LLC
Practice address
5520 Park Ave
Suite WP-2-300
Trumbull, CT 06611-3463
Phone
(203) 374-0310
Fax
(203) 374-0314
NPI assigned
Mar 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shareef Jandali, MDNPI 1265598130
Title
Owner
Phone
(203) 374-0310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X 049538 CT Primary

Addresses

Primary practice location

5520 Park Ave
Suite WP-2-300
Trumbull, CT 06611-3463

Mailing address

5520 Park Ave
Suite WP-2-300
Trumbull, CT 06611-3463
Phone (203) 374-0310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110512000812 CT Part B Supplier - Clinic/Group Practice 4981880648 Receives reassigned benefits from 8 practitioners
Practice locations: Trumbull, CT

National Provider Directory

National Provider Directory

Locations

5520 Park Ave
Ste WP2300
Trumbull, CT 06611
Phone (203) 374-0310

5520 Park Ave
#M2300
Trumbull, CT 06611
Phone (203) 374-0310

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1730488982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5520 PARK AVE",
            "address_2": "SUITE WP-2-300",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066113463",
            "telephone_number": "203-374-0310",
            "fax_number": "203-374-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5520 PARK AVE",
            "address_2": "SUITE WP-2-300",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066113463",
            "telephone_number": "203-374-0310",
            "fax_number": "203-374-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAREEF JANDALI PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-26",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "JANDALI",
        "authorized_official_first_name": "SHAREEF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-374-0310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CT",
            "license": "049538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.