Provider Demographics
NPI:1831500636
Name:SHARMA, GOLDY (PA-C)
Entity type:Individual
Prefix:
First Name:GOLDY
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-3197
Mailing Address - Fax:
Practice Address - Street 1:16850 BEAR VALLEY RD # 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5795
Practice Address - Country:US
Practice Address - Phone:760-241-8000
Practice Address - Fax:760-241-2140
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52401363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical