Healthcare Provider Details

I. General information

NPI: 1053043034
Provider Name (Legal Business Name): SHARMETHA RAMANAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 08/21/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 SANTA MONICA BLVD APT 4711
LOS ANGELES CA
90038-1994
US

IV. Provider business mailing address

16 WINSTON AVE
WILMINGTON MA
01887-2844
US

V. Phone/Fax

Practice location:
  • Phone: 978-697-6412
  • Fax:
Mailing address:
  • Phone: 978-697-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95021790
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2347915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: