MEDICARE: MS. SHARMISTHA PANDA APRN

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	363LA2100X	Acute Care Nurse Practitioner	AP135166	TX

General Provider Information

NPI Number	:	1295247500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARMISTHA PANDA APRN

Provider Business Mailing Address
First Line	:	11226 S WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4313
Country	:	US
Telephone Number	:	281-977-7462
Fax Number	:

Provider Business Practice Location Address
First Line	:	11226 S WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4313
Country	:	US
Telephone Number	:	281-977-7462
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	11/17/2021

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