Provider Demographics
NPI:1316316631
Name:SHINDE, SHARON RAVIKANT
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:RAVIKANT
Last Name:SHINDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:RAVIKANT
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:735 HARRISON AVE APT W103
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:735 HARRISON AVE
Practice Address - Street 2:APT W103
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4903
Practice Address - Country:US
Practice Address - Phone:443-695-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAD1857070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist