Provider Demographics
NPI:1104991058
Name:BHADURI, SHARMILA (MS)
Entity type:Individual
Prefix:MRS
First Name:SHARMILA
Middle Name:
Last Name:BHADURI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SUNSET RIV
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3024
Mailing Address - Country:US
Mailing Address - Phone:949-413-1452
Mailing Address - Fax:
Practice Address - Street 1:16152 BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3869
Practice Address - Country:US
Practice Address - Phone:714-841-6772
Practice Address - Fax:949-583-7973
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist