Provider Demographics
NPI:1013021435
Name:SHARDA, NEERA (MD)
Entity Type:Individual
Prefix:
First Name:NEERA
Middle Name:
Last Name:SHARDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 SOUTHFORK RD
Mailing Address - Street 2:STE 200/220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3201
Mailing Address - Country:US
Mailing Address - Phone:314-543-5942
Mailing Address - Fax:314-543-5947
Practice Address - Street 1:12700 SOUTHFORK RD
Practice Address - Street 2:STE 200/220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3201
Practice Address - Country:US
Practice Address - Phone:314-543-5942
Practice Address - Fax:314-543-5947
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106436305R00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156440103OtherMEDICARE PTAN
MO204770127Medicaid
MOF95045Medicare UPIN
MO000095115Medicare ID - Type Unspecified