Provider Demographics
NPI:1245363522
Name:SHARMA, CHANCHAL (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHANCHAL
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CHANCHAL
Other - Middle Name:S
Other - Last Name:SRITHARAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 E 77TH ST APT 609
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10162-0014
Mailing Address - Country:US
Mailing Address - Phone:917-513-5834
Mailing Address - Fax:718-991-2931
Practice Address - Street 1:222 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5405
Practice Address - Country:US
Practice Address - Phone:646-888-4128
Practice Address - Fax:646-888-4017
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical