Basic Information
| Provider Information | |||||||||
| NPI: | 1134546690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | BHAWNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 BOND AVE | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622072328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183322083 | ||||||||
| FaxNumber: | 6183376039 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 BOND AVE | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622072328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183322083 | ||||||||
| FaxNumber: | 6183376039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2014 | ||||||||
| LastUpdateDate: | 08/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ABO797603 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 036140669 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.