Healthcare Provider Details

I. General information

NPI: 1699775767
Provider Name (Legal Business Name): SUNIL SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CIRCLE OF HOPE DR #3380
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

2000 CIRCLE OF HOPE DR #3380
SALT LAKE CITY UT
84112-5550
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-0303
  • Fax: 801-585-0101
Mailing address:
  • Phone: 801-585-0303
  • Fax: 801-585-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number11224
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: