Provider Demographics
NPI:1356487656
Name:SHARMA, SHASHI K (DM)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOW PLZ STE 208
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6213
Mailing Address - Country:US
Mailing Address - Phone:559-625-4278
Mailing Address - Fax:559-625-4276
Practice Address - Street 1:100 WILLOW PLZ STE 208
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6213
Practice Address - Country:US
Practice Address - Phone:559-625-4278
Practice Address - Fax:559-625-4276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443400Medicaid
CA00A443400Medicaid
CA00A443400Medicare PIN