Provider Demographics
NPI:1558981142
Name:SHARMA, SHRAYA
Entity Type:Individual
Prefix:
First Name:SHRAYA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 WAVERLEY OAKS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8475
Mailing Address - Country:US
Mailing Address - Phone:781-642-7500
Mailing Address - Fax:
Practice Address - Street 1:271 WAVERLEY OAKS RD STE 101
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8475
Practice Address - Country:US
Practice Address - Phone:781-642-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18587641223E0200X, 1223E0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program