Healthcare Provider Details

I. General information

NPI: 1386872299
Provider Name (Legal Business Name): SHIVANI SHARMA RD, LD, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 COOLIDGE HWY STE 200
TROY MI
48084-7068
US

IV. Provider business mailing address

1380 COOLIDGE HWY STE 200
TROY MI
48084-7068
US

V. Phone/Fax

Practice location:
  • Phone: 248-545-2131
  • Fax:
Mailing address:
  • Phone: 248-545-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: