Healthcare Provider Details

I. General information

NPI: 1427219138
Provider Name (Legal Business Name): VISHNUMURTHY SHUSHRUTHA HEDNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax: 812-981-6505
Mailing address:
  • Phone: 812-944-7701
  • Fax: 812-981-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01076976A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number49806
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: