Healthcare Provider Details

I. General information

NPI: 1174016349
Provider Name (Legal Business Name): SHARMILA BISARIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CENTENNIAL BLVD STE 202
VOORHEES NJ
08043-4637
US

IV. Provider business mailing address

900 CENTENNIAL BLVD STE 202
VOORHEES NJ
08043-4637
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6770
  • Fax:
Mailing address:
  • Phone: 568-325-6770
  • Fax: 856-325-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT018666
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number25MB11158500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: