Healthcare Provider Details

I. General information

NPI: 1689986002
Provider Name (Legal Business Name): SHEENA SHARMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE 200
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

3200 E CAMELBACK RD 250
PHOENIX AZ
85018-2311
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-0965
  • Fax: 602-933-4701
Mailing address:
  • Phone: 602-933-1814
  • Fax: 602-933-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51447
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number51447
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: