Provider Demographics
NPI:1629369590
Name:SHARMA, PRIYA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 SUN N LAKE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2138
Mailing Address - Country:US
Mailing Address - Phone:863-402-3161
Mailing Address - Fax:863-402-8244
Practice Address - Street 1:4301 SUN N LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872
Practice Address - Country:US
Practice Address - Phone:863-402-3161
Practice Address - Fax:863-402-8244
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016670208600000X
FLME138796208600000X
PAMT199022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery