Healthcare Provider Details

I. General information

NPI: 1144146887
Provider Name (Legal Business Name): SHARON ANNA VARUGHESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

620 SUGAR TRAIL DR
LEAGUE CITY TX
77573-7416
US

V. Phone/Fax

Practice location:
  • Phone: 309-665-5996
  • Fax:
Mailing address:
  • Phone: 971-825-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.088730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: