Healthcare Provider Details

I. General information

NPI: 1629657093
Provider Name (Legal Business Name): VENKATA ANISHA GUDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 UNICORN LAKE BLVD, BLDG 4, STE 142
DENTON TX
76210-0115
US

IV. Provider business mailing address

7300 RANCH ROAD 2222, BLDG 1, STE 200
AUSTIN TX
78730-3255
US

V. Phone/Fax

Practice location:
  • Phone: 940-222-3724
  • Fax:
Mailing address:
  • Phone: 512-628-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberV7897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: