Provider Demographics
NPI:1538166269
Name:BERG, SHARI ALISSA (DO)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:ALISSA
Last Name:BERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 SEMINOLE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3239
Mailing Address - Country:US
Mailing Address - Phone:727-319-8900
Mailing Address - Fax:
Practice Address - Street 1:11200 SEMINOLE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3239
Practice Address - Country:US
Practice Address - Phone:727-319-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267469600Medicaid
FLP00922489OtherMEDICARE RAILROAD PROVIDER NUMBER
FLPN929OtherMCR PTAN
FL79123UMedicare PIN
FL267469600Medicaid