Healthcare Provider Details

I. General information

NPI: 1992799837
Provider Name (Legal Business Name): PRADEEP S SHARDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ORCHARD ST
HORNELL NY
14843-2111
US

IV. Provider business mailing address

21 ORCHARD ST
HORNELL NY
14843-2111
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-0061
  • Fax: 607-324-7547
Mailing address:
  • Phone: 607-324-0061
  • Fax: 607-324-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number203350-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number203350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: