Provider Demographics
NPI:1679574586
Name:SHARMA, MICKY M (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICKY
Middle Name:M
Last Name:SHARMA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3640 COLONEL GLENN HWY
Mailing Address - Street 2:FAWC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-775-3407
Mailing Address - Fax:937-775-3421
Practice Address - Street 1:3640 COLONEL GLENN HWY
Practice Address - Street 2:FAWC
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45435-0001
Practice Address - Country:US
Practice Address - Phone:937-775-3407
Practice Address - Fax:937-775-3421
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH5626103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical