Healthcare Provider Details

I. General information

NPI: 1558437731
Provider Name (Legal Business Name): SHARDHA K SABESAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARDHA KUPPUSWAMY

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

IV. Provider business mailing address

4606 CENTRAL TER
WILMINGTON DE
19802-1741
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-5257
  • Fax: 610-874-7241
Mailing address:
  • Phone: 302-355-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD430117
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: