Basic Information
| Provider Information | |||||||||
| NPI: | 1245325562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | PRIYANKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SURANA | ||||||||
| OtherFirstName: | PRIYANKA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2330 SHAWNEE MISSION PARKWAY | ||||||||
| Address2: | SUITE 210, MS 5003 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886029 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2330 SHAWNEE MISSION PARKWAY | ||||||||
| Address2: | SUITE 210, MS 5003 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886029 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 05/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 04-29252 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 29331028 | 01 | MO | BCBS KC | OTHER | 100398430A | 05 | KS | MEDICAID | 411330 | 01 | KS | FIRSTGUARD | OTHER | 205365908 | 05 | MO | MEDICAID |