MEDICARE: DR. VINAY SHARMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	ME78919	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01560984	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11356	OTHER	FL	DIMENSION HEALTH PPO
2	264774	OTHER	FL	AVMED
3	49296	OTHER	FL	BLUE CROSS BLUE SHIELD
4	P970934	OTHER	FL	OPTIMUM
6	49296	OTHER	FL	BCBS
7	902478	OTHER	FL	WELLCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	5051500	OTHER	FL	AETNA
10	P1015181	OTHER	FL	FREEDOM
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164425237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINAY SHARMA M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	21020 STATE ROAD 7
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1320
Country	:	US
Telephone Number	:	561-883-8656
Fax Number	:	561-883-8658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/20/2016

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