Healthcare Provider Details

I. General information

NPI: 1669678363
Provider Name (Legal Business Name): SHIPRA M PUTATUNDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/01/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 NORTHWOODS CV
MURFREESBORO TN
37130-1130
US

IV. Provider business mailing address

1418 NORTHWOODS CV
MURFREESBORO TN
37130-1130
US

V. Phone/Fax

Practice location:
  • Phone: 615-397-4298
  • Fax:
Mailing address:
  • Phone: 615-397-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD0000025786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: