Healthcare Provider Details

I. General information

NPI: 1720754526
Provider Name (Legal Business Name): SHOBHIT SHARMA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 W US HIGHWAY 20
MIDDLEBURY IN
46540-9713
US

IV. Provider business mailing address

PO BOX 834
GOSHEN IN
46527-0834
US

V. Phone/Fax

Practice location:
  • Phone: 574-825-8068
  • Fax: 574-825-4873
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003466A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: