Provider Demographics
NPI:1164425237
Name:SHARMA, VINAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:21020 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1320
Practice Address - Country:US
Practice Address - Phone:561-883-8656
Practice Address - Fax:561-883-8658
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME789192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11356OtherDIMENSION HEALTH PPO
FL264774OtherAVMED
FL49296OtherBLUE CROSS BLUE SHIELD
FLP970934OtherOPTIMUM
FLP01560984OtherRR MEDICARE
FL49296OtherBCBS
FL902478OtherWELLCARE
FL257538800Medicaid
FL5051500OtherAETNA
FLP1015181OtherFREEDOM
FL902478OtherWELLCARE
FL49296OtherBCBS
FL49296TMedicare PIN