Provider Demographics
NPI:1275380966
Name:SHARMA, MEENAL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MEENAL
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MEENAL
Other - Middle Name:
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8373 BLACKMAN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4063
Mailing Address - Country:US
Mailing Address - Phone:916-402-2972
Mailing Address - Fax:
Practice Address - Street 1:8373 BLACKMAN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4063
Practice Address - Country:US
Practice Address - Phone:916-402-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028313363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care