Healthcare Provider Details

I. General information

NPI: 1689866493
Provider Name (Legal Business Name): DEEPA S SHARMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEPA S TAGGARSHE MD

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E HERNDON AVE STE 210
FRESNO CA
93720-3333
US

IV. Provider business mailing address

22250 PROVIDENCE DR SUITE 702
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-7200
  • Fax: 559-450-7214
Mailing address:
  • Phone: 248-557-9650
  • Fax: 248-557-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301089750
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC202066
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301089750
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberC202066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: