Provider Demographics
NPI:1760044796
Name:PATIBANDLA, SHARON LEELA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:SHARON LEELA
Middle Name:
Last Name:PATIBANDLA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 GATES CT
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3472
Mailing Address - Country:US
Mailing Address - Phone:862-222-7234
Mailing Address - Fax:
Practice Address - Street 1:246 CLIFTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1953
Practice Address - Country:US
Practice Address - Phone:973-928-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00493500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical