Provider Demographics
NPI:1730221854
Name:SHARDA SUN MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:SHARDA SUN MEDICAL GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAVNEET
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-212-2864
Mailing Address - Street 1:3509 E. HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121
Mailing Address - Country:US
Mailing Address - Phone:702-212-2864
Mailing Address - Fax:702-547-6818
Practice Address - Street 1:3509 E. HARMON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-212-2864
Practice Address - Fax:702-547-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8200207RX0202X
2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V38930Medicare UPIN