Provider Demographics
NPI:1902091663
Name:SHARMA, SANDEEP K (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ROCKEFELLER AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1677
Mailing Address - Country:US
Mailing Address - Phone:425-316-5490
Mailing Address - Fax:425-259-8600
Practice Address - Street 1:1330 ROCKEFELLER AVE STE 310
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1677
Practice Address - Country:US
Practice Address - Phone:425-316-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174007207RC0000X, 207RC0001X
WAMD61207667207RC0000X, 207RC0001X
PAMD458578207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103134379 0002Medicaid
PA103134379 0002Medicaid