Provider Demographics
NPI:1578549531
Name:SHARMA, VIJAI P (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIJAI
Middle Name:P
Last Name:SHARMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N OCOEE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3919
Mailing Address - Country:US
Mailing Address - Phone:423-476-1933
Mailing Address - Fax:423-476-3534
Practice Address - Street 1:2150 N OCOEE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3919
Practice Address - Country:US
Practice Address - Phone:423-476-1933
Practice Address - Fax:423-476-3534
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3690135Medicare ID - Type Unspecified