Healthcare Provider Details

I. General information

NPI: 1174256382
Provider Name (Legal Business Name): SNEHA PUVVADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORTH BLVD STE 130
BATON ROUGE LA
70806-3743
US

IV. Provider business mailing address

8451 PICARDY AVE APT 2311
BATON ROUGE LA
70809-3777
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7900
  • Fax:
Mailing address:
  • Phone: 225-888-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0102574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: