Healthcare Provider Details

I. General information

NPI: 1710093661
Provider Name (Legal Business Name): SHURA S HEGDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 ROCKSIDE RD STE 207 ROCKSIDE SQUARE 2
INDEPENDENCE OH
44131
US

IV. Provider business mailing address

6133 ROCKSIDE RD STE 207 ROCKSIDE SQUARE 2
INDEPENDENCE OH
44131
US

V. Phone/Fax

Practice location:
  • Phone: 216-520-5969
  • Fax: 216-520-5098
Mailing address:
  • Phone: 216-520-5969
  • Fax: 216-520-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35068706H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: