Provider Demographics
NPI:1053043034
Name:RAMANAN, SHARMETHA
Entity Type:Individual
Prefix:
First Name:SHARMETHA
Middle Name:
Last Name:RAMANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2844
Mailing Address - Country:US
Mailing Address - Phone:978-697-6412
Mailing Address - Fax:
Practice Address - Street 1:6677 SANTA MONICA BLVD APT 4711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-1994
Practice Address - Country:US
Practice Address - Phone:978-697-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2347915163W00000X
CA95021790363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse