Healthcare Provider Details

I. General information

NPI: 1881718492
Provider Name (Legal Business Name): SHARMILARANI NANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST EXCELA HEALTHWESTMORELAND
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 62063 EXCELA HEALTHWESTMORELAND
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21329
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: