Healthcare Provider Details

I. General information

NPI: 1043904055
Provider Name (Legal Business Name): SIMA SHARMA TIWARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

438 PLANTATION ST
WORCESTER MA
01605-2328
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-3271
  • Fax: 508-856-5911
Mailing address:
  • Phone: 508-762-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2304583
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2304583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: