Provider Demographics
NPI:1053956292
Name:SHARMA, DEEPAK
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 SNOW DRIFT CIR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1572
Mailing Address - Country:US
Mailing Address - Phone:630-550-1058
Mailing Address - Fax:
Practice Address - Street 1:437 W STATE ST APT 101
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1458
Practice Address - Country:US
Practice Address - Phone:630-550-1058
Practice Address - Fax:815-205-4545
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily