Provider Demographics
NPI:1730960493
Name:SHARMA, KANKSHA (PT)
Entity type:Individual
Prefix:
First Name:KANKSHA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KANKSHA
Other - Middle Name:HARDIKBHAI
Other - Last Name:BHATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:32 HEATHCOTE AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4769
Mailing Address - Country:US
Mailing Address - Phone:973-814-7442
Mailing Address - Fax:
Practice Address - Street 1:584 BROADWAY RM 606
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-5243
Practice Address - Country:US
Practice Address - Phone:973-814-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049741-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist