Healthcare Provider Details

I. General information

NPI: 1871448639
Provider Name (Legal Business Name): ANISHA SHARMA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W OUTER DR STE 114
DETROIT MI
48235-2626
US

IV. Provider business mailing address

259 MACK AVE
DETROIT MI
48201-2427
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: