Provider Demographics
NPI:1407029010
Name:NEERA SHARDA LLC
Entity Type:Organization
Organization Name:NEERA SHARDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-9975
Mailing Address - Street 1:10004 KENNERLY ROAD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-5107
Mailing Address - Country:US
Mailing Address - Phone:314-842-9975
Mailing Address - Fax:314-842-5535
Practice Address - Street 1:10004 KENNERLY ROAD
Practice Address - Street 2:SUITE 200A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5107
Practice Address - Country:US
Practice Address - Phone:314-842-9975
Practice Address - Fax:314-842-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD106436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF95045Medicare UPIN