Individual
DR. IRINA YURYEVNA KHARISOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-3644
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-8544
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME151917
FL
2084V0102X
Vascular Neurology Physician
ME151917
FL
208M00000X
Hospitalist Physician
ME151917
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113755500
—
FL
01
—
PJ504
MEDICARE HF
FL
Enumeration date
03/26/2017
Last updated
11/03/2023
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