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General NPI Number Information
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NPI Number | 1760044796
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Entity Type | Individual
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Provider Name | SHARON LEELA PATIBANDLA PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 06/29/2019
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Last Update Date | 06/29/2019
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Provider Practice Location Address
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Address Line | 246 CLIFTON AVE STE 4
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City | CLIFTON
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State | NJ
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Zip | 07011-1953
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Country | US
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Telephone | 973-928-2715
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 GATES CT
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City | MORRIS PLAINS
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State | NJ
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Zip | 07950-3472
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Country | US
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Telephone | 862-222-7234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00493500
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License Number State | NJ
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