Provider Demographics
NPI:1073900130
Name:SHARMA, RAHUL
Entity Type:Individual
Prefix:MR
First Name:RAHUL
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SUTTON ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4424
Mailing Address - Country:US
Mailing Address - Phone:917-423-5196
Mailing Address - Fax:
Practice Address - Street 1:28 SUTTON ST
Practice Address - Street 2:APT 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4424
Practice Address - Country:US
Practice Address - Phone:917-423-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007363OtherNYS DEPARTMENT OF EDUCATION