Healthcare Provider Details

I. General information

NPI: 1265960652
Provider Name (Legal Business Name): DIVYANSH SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S PRESTON ST RM 305
LOUISVILLE KY
40202-1702
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD STE 230
LAS VEGAS NV
89102-2312
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-8696
  • Fax:
Mailing address:
  • Phone: 702-671-2345
  • Fax: 702-671-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: