Provider Demographics
NPI:1780878868
Name:NELSON, SHARMEEN (M D)
Entity type:Individual
Prefix:
First Name:SHARMEEN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:SHARMEEN
Other - Middle Name:
Other - Last Name:SARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:2327 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1851
Practice Address - Country:US
Practice Address - Phone:208-642-9376
Practice Address - Fax:208-642-9598
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD126153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD126153OtherOREGON LICENSE NUMBER
ORMD126153OtherOREGON LICENSE NUMBER