Provider Demographics
NPI:1811211253
Name:SHARMA, PRASHANT (DO)
Entity Type:Individual
Prefix:
First Name:PRASHANT
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 N 16TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5344
Mailing Address - Country:US
Mailing Address - Phone:602-266-8700
Mailing Address - Fax:602-296-0404
Practice Address - Street 1:1400 W LOMBARD ST UNIT 691
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-3134
Practice Address - Country:US
Practice Address - Phone:443-317-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO0346302084P0800X
KS05-353272083A0100X
AZ0093642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine