Healthcare Provider Details

I. General information

NPI: 1366517617
Provider Name (Legal Business Name): SHARAD V GUNDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 HAIFLEIGH ST
FRANKLIN LA
70538-3731
US

IV. Provider business mailing address

606 HAIFLEIGH ST
FRANKLIN LA
70538-3731
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-4440
  • Fax: 337-828-4265
Mailing address:
  • Phone: 337-828-4440
  • Fax: 337-828-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12761R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: