Individual
SHARMILA SURI MOHANRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1125 MADISON ST, CAPITAL REGION PHYSICIANS, JEFFERSON CITY, MO 65101-5227
(573) 632-5560
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
2015004633
MO
282N00000X
General Acute Care Hospital
2011017409
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200022885
—
MO
01
—
2015004633
STATE LICENSE
MO
Enumeration date
08/12/2011
Last updated
11/08/2021
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