Healthcare Provider Details

I. General information

NPI: 1588185367
Provider Name (Legal Business Name): SHARANA HEGDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8877 LAKES AT 610 DR APT 477
HOUSTON TX
77054-2589
US

IV. Provider business mailing address

8877 LAKES AT 610 DR APT 477
HOUSTON TX
77054-2589
US

V. Phone/Fax

Practice location:
  • Phone: 310-994-6595
  • Fax:
Mailing address:
  • Phone: 310-994-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2024-01199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: