Healthcare Provider Details

I. General information

NPI: 1720930555
Provider Name (Legal Business Name): MISRA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8232 LOUISIANA BLVD NE STE A
ALBUQUERQUE NM
87113-2429
US

IV. Provider business mailing address

3801 CALLE PINO NE
ALBUQUERQUE NM
87111-4342
US

V. Phone/Fax

Practice location:
  • Phone: 505-221-6342
  • Fax: 505-212-4581
Mailing address:
  • Phone: 505-221-6342
  • Fax: 505-212-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEILA MISRA
Title or Position: APN/OWNER
Credential: APN
Phone: 505-221-6342