Provider Demographics
NPI:1730396706
Name:SHARMA, AMIT KUMAR (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:KUMAR
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 1:3155 SUNTREE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5720
Mailing Address - Country:US
Mailing Address - Phone:321-441-8749
Mailing Address - Fax:888-571-3160
Practice Address - Street 1:915 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4530
Practice Address - Country:US
Practice Address - Phone:321-441-8749
Practice Address - Fax:888-571-3160
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28300207R00000X
FLME132574207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1730396706Medicaid
AL102028Medicaid
AL51009501OtherBCBS OF AL
AL1609945906Medicare PIN
ALP00651220Medicare PIN
AL1184738478Medicare PIN
AL102028Medicaid