Provider Demographics
NPI:1871004176
Name:SHARMA, EKTA (DO)
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-462-8323
Mailing Address - Fax:954-463-1149
Practice Address - Street 1:2866 E OAKLAND PARK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1819
Practice Address - Country:US
Practice Address - Phone:954-462-8323
Practice Address - Fax:954-463-1149
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO4570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUO4570Medicaid