=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407915804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SWATI DAVE-SHARMA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 03/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 E 149TH ST
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10451-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-579-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 234 E 149TH ST PEDIATRICS, RM 420. LINCOLN MEDICAL CENTER
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10451-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | 200281
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------