Provider Demographics
NPI:1548613482
Name:SHARMA, RAHUL (LPN)
Entity Type:Individual
Prefix:MR
First Name:RAHUL
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:RAHUL
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3418 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2807
Mailing Address - Country:US
Mailing Address - Phone:929-268-6969
Mailing Address - Fax:
Practice Address - Street 1:3418 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2807
Practice Address - Country:US
Practice Address - Phone:929-268-6969
Practice Address - Fax:718-425-0880
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219510164W00000X
NY297482164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse