Provider Demographics
NPI:1437714656
Name:SHARMA, KANISHK DEEP
Entity type:Individual
Prefix:
First Name:KANISHK
Middle Name:DEEP
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N BROADWAY STE 417
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 N BROADWAY STE 417
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1083
Practice Address - Country:US
Practice Address - Phone:914-366-3677
Practice Address - Fax:914-366-1459
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320395207RG0300X
VA0101274457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine