Healthcare Provider Details

I. General information

NPI: 1285079178
Provider Name (Legal Business Name): NIDHI SHAROHA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 QUEENS ST
SYOSSET NY
11791-3058
US

IV. Provider business mailing address

60 QUEENS ST
SYOSSET NY
11791-3058
US

V. Phone/Fax

Practice location:
  • Phone: 844-263-0400
  • Fax:
Mailing address:
  • Phone: 844-263-0400
  • Fax: 855-263-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number284158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: