Provider Demographics
NPI:1386872299
Name:SHARMA, SHIVANI (RD, LD, CLT)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:RD, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3738
Mailing Address - Country:US
Mailing Address - Phone:214-597-6064
Mailing Address - Fax:888-263-1392
Practice Address - Street 1:120 S DENTON TAP RD
Practice Address - Street 2:SUITE 270-A
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3297
Practice Address - Country:US
Practice Address - Phone:214-597-6064
Practice Address - Fax:888-263-1392
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81088133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L15573Medicare PIN
TX8L15780Medicare PIN
TX8L15779Medicare PIN