Healthcare Provider Details

I. General information

NPI: 1134546690
Provider Name (Legal Business Name): BHAWNA SHARMA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BOND AVE
CENTREVILLE IL
62207-2328
US

IV. Provider business mailing address

6000 BOND AVE
CENTREVILLE IL
62207-2328
US

V. Phone/Fax

Practice location:
  • Phone: 618-332-2083
  • Fax: 618-337-6039
Mailing address:
  • Phone: 618-332-2083
  • Fax: 618-337-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberABO797603
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024049029
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036140669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: