Provider Demographics
NPI:1386980175
Name:MANSUKANI, SHARAD SUNDER (MD)
Entity type:Individual
Prefix:DR
First Name:SHARAD
Middle Name:SUNDER
Last Name:MANSUKANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PARK LN
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2000
Mailing Address - Country:US
Mailing Address - Phone:856-234-4382
Mailing Address - Fax:
Practice Address - Street 1:411 PARK LN
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2000
Practice Address - Country:US
Practice Address - Phone:856-234-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-24
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 062217L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology