Provider Demographics
NPI:1366785461
Name:MEHTA, SHARMILA BANDYOPADHYAY (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARMILA
Middle Name:BANDYOPADHYAY
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 THOMPSON FARM
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1492
Mailing Address - Country:US
Mailing Address - Phone:781-330-6305
Mailing Address - Fax:
Practice Address - Street 1:4202 THOMPSON FARM
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1492
Practice Address - Country:US
Practice Address - Phone:781-330-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9633103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical