Provider Demographics
NPI:1720440100
Name:SHARMA, CHETAN
Entity Type:Individual
Prefix:MR
First Name:CHETAN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WOODCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUTTONTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-333-4109
Mailing Address - Fax:516-501-9501
Practice Address - Street 1:400 POST AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-501-9500
Practice Address - Fax:516-501-9501
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency