Provider Demographics
NPI:1467509927
Name:MUKHERJEE, SHARMI (MPT)
Entity Type:Individual
Prefix:
First Name:SHARMI
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 HAVEN AVE UNIT A419
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39141 CIVIC CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5831
Practice Address - Country:US
Practice Address - Phone:510-794-9672
Practice Address - Fax:510-792-8138
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT332800OtherBLUE SHIELD OF CALIFORNIA
CAPT0332800Medicaid
CA0PT332800Medicare PIN