Provider Demographics
NPI:1104531342
Name:SHARMA BASYAL, PRAGYASHREE (PA-C)
Entity type:Individual
Prefix:
First Name:PRAGYASHREE
Middle Name:
Last Name:SHARMA BASYAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2010
Mailing Address - Country:US
Mailing Address - Phone:443-303-7076
Mailing Address - Fax:
Practice Address - Street 1:1235 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5327
Practice Address - Country:US
Practice Address - Phone:443-303-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008766207QA0505X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine