Provider Demographics
NPI:1124251871
Name:SHARMA, JITENDRA (MBBS)
Entity type:Individual
Prefix:
First Name:JITENDRA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD STE 372
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7807
Mailing Address - Country:US
Mailing Address - Phone:205-802-6595
Mailing Address - Fax:205-802-6598
Practice Address - Street 1:513 BROOKWOOD BLVD STE 372
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7807
Practice Address - Country:US
Practice Address - Phone:205-802-6595
Practice Address - Fax:205-802-6598
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPPLIED2084V0102X
SD82322084V0102X
AL350832084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology