Provider Demographics
NPI:1780112979
Name:VISAKAN, SHARANYA (MD)
Entity type:Individual
Prefix:
First Name:SHARANYA
Middle Name:
Last Name:VISAKAN
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 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-802-7600
Mailing Address - Fax:845-338-0307
Practice Address - Street 1:1 FAMILY PRACTICE DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6449
Practice Address - Country:US
Practice Address - Phone:845-338-6400
Practice Address - Fax:845-339-7288
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0661207P00000X
390200000X
IN01083794A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program