Healthcare Provider Details

I. General information

NPI: 1164345831
Provider Name (Legal Business Name): SHARON IMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 SUMMERSON RD
BALTIMORE MD
21209-2516
US

IV. Provider business mailing address

2520 SUMMERSON RD
BALTIMORE MD
21209-2516
US

V. Phone/Fax

Practice location:
  • Phone: 917-702-4121
  • Fax:
Mailing address:
  • Phone: 917-702-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR253711
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: