Provider Demographics
NPI:1346695855
Name:SHARMA, MIRDULA
Entity type:Individual
Prefix:
First Name:MIRDULA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8129
Mailing Address - Country:US
Mailing Address - Phone:718-708-4594
Mailing Address - Fax:
Practice Address - Street 1:2901 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8129
Practice Address - Country:US
Practice Address - Phone:718-708-4594
Practice Address - Fax:347-326-7217
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY301108208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program