Healthcare Provider Details

I. General information

NPI: 1508426057
Provider Name (Legal Business Name): TANYA SHARMA M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 CROSS ST STE 2940
SHILOH IL
62269-2988
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 618-607-3700
  • Fax: 618-624-4841
Mailing address:
  • Phone: 618-607-3700
  • Fax: 618-624-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036179999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: