Provider Demographics
NPI:1124169396
Name:DEVIDOSS, SHARMILA (MD)
Entity type:Individual
Prefix:DR
First Name:SHARMILA
Middle Name:
Last Name:DEVIDOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NINOO
Other - Middle Name:
Other - Last Name:DEVIDOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:701 MONTE CARLO DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1159
Mailing Address - Country:US
Mailing Address - Phone:817-733-9367
Mailing Address - Fax:
Practice Address - Street 1:701 MONTE CARLO DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1159
Practice Address - Country:US
Practice Address - Phone:817-733-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15390R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology