Healthcare Provider Details

I. General information

NPI: 1912700337
Provider Name (Legal Business Name): MR. NISHANT SHARMA BANJARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date: 11/14/2025
Reactivation Date: 08/12/2026

III. Provider practice location address

101 DATES DRIVE, CAYUGA MEDICAL CENTER
ITHACA NY
14850
US

IV. Provider business mailing address

101 DATES DRIVE, INTERNAL MEDICINE RESIDENCY CAYUGA MED
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-339-0494
  • Fax:
Mailing address:
  • Phone: 607-339-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: