Provider Demographics
NPI:1982652574
Name:SHARMA, MANISH R (DO)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:R
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 1:26606 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-8545
Mailing Address - Country:US
Mailing Address - Phone:813-907-0123
Mailing Address - Fax:813-907-5559
Practice Address - Street 1:26606 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8545
Practice Address - Country:US
Practice Address - Phone:813-907-0123
Practice Address - Fax:813-907-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9680208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00644445OtherRAILROAD MEDICARE
FLAB766XOtherMEDICARE
FLOS9680OtherMEDICAL LICENSE
FL14M83OtherBCBS
FL281078600Medicaid