Provider Demographics
NPI:1598096778
Name:KAVITA SHARMA, D.O., PL
Entity Type:Organization
Organization Name:KAVITA SHARMA, D.O., PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-306-0594
Mailing Address - Street 1:1551 CROWNE VIEW DR
Mailing Address - Street 2:# 818
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0654
Mailing Address - Country:US
Mailing Address - Phone:201-306-0594
Mailing Address - Fax:
Practice Address - Street 1:1671 N CLYDE MORRIS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5590
Practice Address - Country:US
Practice Address - Phone:386-274-2977
Practice Address - Fax:386-274-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10120208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty