Healthcare Provider Details

I. General information

NPI: 1770994071
Provider Name (Legal Business Name): SHREYA SHARON GONDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 02/11/2022
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 CAMDEN AVE STE 107
SAN JOSE CA
95120-2847
US

IV. Provider business mailing address

1800 HARRISON ST FL 7
OAKLAND CA
94612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 408-268-4900
  • Fax:
Mailing address:
  • Phone: 510-625-2856
  • Fax: 877-738-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA139837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: