Provider Demographics
NPI:1568753846
Name:SHARMA, NITIN (MD)
Entity type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:SHARMA
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 1:1920 DON WICKHAM DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1978
Mailing Address - Country:US
Mailing Address - Phone:352-536-8761
Mailing Address - Fax:321-841-2120
Practice Address - Street 1:1920 DON WICKHAM DR STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1978
Practice Address - Country:US
Practice Address - Phone:352-536-8761
Practice Address - Fax:321-841-2120
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93074208800000X
IL036145903208800000X
FLME168701208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIZ915ZOtherMEDICARE
FL123008500Medicaid