Healthcare Provider Details

I. General information

NPI: 1619243193
Provider Name (Legal Business Name): SHIVA SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 MOUNTAIN ROAD PL NE STE N
ALBUQUERQUE NM
87110-7845
US

IV. Provider business mailing address

1650 FILLMORE ST APT 1006
DENVER CO
80206-1590
US

V. Phone/Fax

Practice location:
  • Phone: 719-966-0534
  • Fax:
Mailing address:
  • Phone: 719-966-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2022-1124
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: