Healthcare Provider Details

I. General information

NPI: 1497848493
Provider Name (Legal Business Name): PAVAN REKHA SHARMA MS., RD., CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 GROVE AVE STE A
VERONA NJ
07044-1731
US

IV. Provider business mailing address

9 BAKLEY TER
WEST ORANGE NJ
07052-2169
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-2600
  • Fax: 973-239-0482
Mailing address:
  • Phone: 739-715-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number860319
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: