Healthcare Provider Details

I. General information

NPI: 1881379162
Provider Name (Legal Business Name): SHUSHMA GUDLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PUBLIC SQ
CLEVELAND OH
44113-1926
US

IV. Provider business mailing address

55 PUBLIC SQ
CLEVELAND OH
44113-1926
US

V. Phone/Fax

Practice location:
  • Phone: 412-512-4619
  • Fax:
Mailing address:
  • Phone: 412-512-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: