MEDICARE: MRS. SHARMILA BHADURI M.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 39475	CA

General Provider Information

NPI Number	:	1104991058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARMILA BHADURI M.S

Provider Business Mailing Address
First Line	:	21 SUNSET RIV
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-3024
Country	:	US
Telephone Number	:	949-413-1452
Fax Number	:

Provider Business Practice Location Address
First Line	:	16152 BEACH BLVD STE 200
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3869
Country	:	US
Telephone Number	:	714-841-6772
Fax Number	:	949-583-7973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	05/28/2020

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