Healthcare Provider Details

I. General information

NPI: 1376774059
Provider Name (Legal Business Name): HIMANSHU SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

IV. Provider business mailing address

PO BOX 677879
ORLANDO FL
32867-7879
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7812
  • Fax: 407-303-0475
Mailing address:
  • Phone: 407-440-3004
  • Fax: 407-429-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT194577
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME121252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: