Provider Demographics
NPI:1265470827
Name:UDASSI, SHARDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARDA
Middle Name:
Last Name:UDASSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARDA
Other - Middle Name:
Other - Last Name:UDASSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-7710
Practice Address - Fax:850-416-6729
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90740208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271120600Medicaid
FL50355YMedicare PIN
FL50355Medicare ID - Type Unspecified
I20462Medicare UPIN
FL50355ZMedicare PIN