Basic Information
Provider Information
NPI: 1407029010
EntityType: 2
ReplacementNPI:  
OrganizationName: NEERA SHARDA LLC
LastName:  
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Mailing Information
Address1: 10004 KENNERLY ROAD
Address2: SUITE 200A
City: ST LOUIS
State: MO
PostalCode: 631285107
CountryCode: US
TelephoneNumber: 3148429975
FaxNumber: 3148425535
Practice Location
Address1: 10004 KENNERLY ROAD
Address2: SUITE 200A
City: ST LOUIS
State: MO
PostalCode: 631285107
CountryCode: US
TelephoneNumber: 3148429975
FaxNumber: 3148425535
Other Information
ProviderEnumerationDate: 04/04/2008
LastUpdateDate: 04/04/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: SHARDA
AuthorizedOfficialFirstName: NEERA
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3148429975
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD106436MOY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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