Provider Demographics
NPI:1366979395
Name:SHARMA, NISHANT (MD)
Entity type:Individual
Prefix:
First Name:NISHANT
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 LYNN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8017
Mailing Address - Country:US
Mailing Address - Phone:805-496-9727
Mailing Address - Fax:805-496-9148
Practice Address - Street 1:2220 LYNN RD STE 102
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8017
Practice Address - Country:US
Practice Address - Phone:805-496-9727
Practice Address - Fax:805-496-9148
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA179070174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist