Provider Demographics
NPI:1528255940
Name:SHARMA, RAVIL RAJ (PSY D)
Entity type:Individual
Prefix:
First Name:RAVIL
Middle Name:RAJ
Last Name:SHARMA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MADISON AVE FL 25
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2212
Mailing Address - Country:US
Mailing Address - Phone:917-482-6782
Mailing Address - Fax:646-202-2401
Practice Address - Street 1:41 MADISON AVE FL 25
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2212
Practice Address - Country:US
Practice Address - Phone:917-482-6782
Practice Address - Fax:646-202-2401
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017285103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist