Provider Demographics
NPI:1073889085
Name:SHARMA, SHRUTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-662-0406
Mailing Address - Fax:928-662-0407
Practice Address - Street 1:151 S OAK AVE STE 6
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336-0756
Practice Address - Country:US
Practice Address - Phone:928-662-0409
Practice Address - Fax:928-662-0410
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55467208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery