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SHAREEF JANDALI PLASTIC SURGERY LLC
NPI 1730488982
Surgery - Plastic and Reconstructive Surgery in Trumbull, CT

Active since March 26, 2011
5520 PARK AVE, SUITE WP-2-300, TRUMBULL, CT 06611(203) 374-0310(203) 374-0314 Get Directions Write a Review

NPPES record last updated: October 11, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Shareef Jandali Plastic Surgery Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHAREEF JANDALI PLASTIC SURGERY LLC (NPI 1730488982) is a healthcare organization registered as a plastic and reconstructive surgery in Trumbull, Connecticut and active in the NPI registry since March 2011. The organization lists Shareef Jandali, Owner, as its authorized official.

NPPES Registry Identity

NPI1730488982
Entity TypeOrganization
Primary Taxonomy2086S0122X
Legal Business NameSHAREEF JANDALI PLASTIC SURGERY LLC
Location Address5520 PARK AVE, SUITE WP-2-300Trumbull, CT 06611-3463
Mailing Address5520 Park Ave, Suite Wp-2-300Trumbull, CT 06611-3463 · (203) 374-0310 · Fax (203) 374-0314
Phone(203) 374-0310
Fax(203) 374-0314
Organization SubpartNo
Authorized OfficialShareef JandaliOwner · (203) 374-0310
Enumeration DateMarch 26, 2011
Last NPPES UpdateOctober 11, 2019
✔ NPI 1730488982 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in CT · 049538
Definition
A surgeon who specializes in plastic and reconstructive surgery.
5520 PARK AVE, Trumbull, CT 06611
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shareef Jandali Plastic Surgery Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateConnecticutEnrollment IDO20110512000812Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Shareef Jandali Plastic Surgery LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Shareef Jandali, MD
Plastic and Reconstructive Surgery
NPI 1265598130
5520 PARK AVE SUITE WP-2-300
Trumbull, CT 06611
(203) 374-0310
✔ PECOS✔ Accepts MedicareSame address
Richard Agag, MD
Plastic and Reconstructive Surgery
NPI 1497937486
1 ROBERT WOOD JOHNSON PL
New Brunswick, NJ 08901
(732) 828-3000
✔ PECOS81 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shareef Jandali Plastic Surgery LLC's NPI number?

The NPI number for Shareef Jandali Plastic Surgery LLC is 1730488982. It was assigned to this organization in the NPPES registry on March 26, 2011.

Where is Shareef Jandali Plastic Surgery LLC located?

Shareef Jandali Plastic Surgery LLC is located at 5520 Park Ave Suite Wp-2-300, Trumbull, CT 06611. The listed phone number is (203) 374-0310.

What is Shareef Jandali Plastic Surgery LLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Shareef Jandali Plastic Surgery LLC enrolled in Medicare?

Yes. Shareef Jandali Plastic Surgery LLC is registered in the Medicare PECOS enrollment system.

When is Shareef Jandali Plastic Surgery LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Connecticut, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Shareef Jandali Plastic Surgery LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Plastic and Reconstructive Surgery, reassign their Medicare billing to Shareef Jandali Plastic Surgery LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Shareef Jandali Plastic Surgery LLC was last updated on October 11, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.