Provider Demographics
NPI:1629598065
Name:SHARMA, RISHI (MD)
Entity Type:Individual
Prefix:DR
First Name:RISHI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LOOKOUT PL
Mailing Address - Street 2:STE 107
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4485
Mailing Address - Country:US
Mailing Address - Phone:864-838-3183
Mailing Address - Fax:866-682-4175
Practice Address - Street 1:260 LOOKOUT PL
Practice Address - Street 2:STE 107
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4485
Practice Address - Country:US
Practice Address - Phone:407-628-4545
Practice Address - Fax:407-637-5679
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14094208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14094OtherINTERNADO