Provider Demographics
NPI:1619363868
Name:SHARMA, STEPHANIE K (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3361
Mailing Address - Country:US
Mailing Address - Phone:626-963-9402
Mailing Address - Fax:626-623-7244
Practice Address - Street 1:440 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3361
Practice Address - Country:US
Practice Address - Phone:626-963-9402
Practice Address - Fax:626-623-7244
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52238363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical