Basic Information
| Provider Information | |||||||||
| NPI: | 1013021435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARDA | ||||||||
| FirstName: | NEERA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12700 SOUTHFORK RD | ||||||||
| Address2: | STE 200/220 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631283201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145435942 | ||||||||
| FaxNumber: | 3145435947 | ||||||||
| Practice Location | |||||||||
| Address1: | 12700 SOUTHFORK RD | ||||||||
| Address2: | STE 200/220 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631283201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145435942 | ||||||||
| FaxNumber: | 3145435947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 03/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 106436 | MO | N | Managed Care Organizations | Preferred Provider Organization | 207R00000X | 106436 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 106436 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 156440103 | 01 | MO | MEDICARE PTAN | OTHER | 204770127 | 05 | MO | MEDICAID |