Healthcare Provider Details

I. General information

NPI: 1790313880
Provider Name (Legal Business Name): JYOTI SHARMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE STE 103A
SEATTLE WA
98105-5667
US

IV. Provider business mailing address

4915 25TH AVE NE STE 103A
SEATTLE WA
98105-5667
US

V. Phone/Fax

Practice location:
  • Phone: 801-664-7638
  • Fax:
Mailing address:
  • Phone: 801-664-7638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number70110809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: