Healthcare Provider Details

I. General information

NPI: 1164452116
Provider Name (Legal Business Name): PRAGYA TIWARI-SHARMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRAGYA TIWARI M.D.

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOBSON RD STE: 203
MESA AZ
85202-4713
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-7100
  • Fax:
Mailing address:
  • Phone: 602-262-8917
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34242
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: