Provider Demographics
NPI:1578023909
Name:RICHARDSON, SHARMA TANISSE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARMA
Middle Name:TANISSE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARMA
Other - Middle Name:TANISSE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1713 W VIRGINIA AVE NE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2359
Mailing Address - Country:US
Mailing Address - Phone:240-304-5238
Mailing Address - Fax:
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-780-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program