Healthcare Provider Details

I. General information

NPI: 1366077612
Provider Name (Legal Business Name): DEVI SATISH SHARMA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 HOLLIS ST
EMERYVILLE CA
94608-2016
US

IV. Provider business mailing address

5800 HOLLIS ST
EMERYVILLE CA
94608-2016
US

V. Phone/Fax

Practice location:
  • Phone: 888-924-1036
  • Fax:
Mailing address:
  • Phone: 888-924-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: