Healthcare Provider Details

I. General information

NPI: 1881810596
Provider Name (Legal Business Name): SHAUN JEFFREY GONDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W 5TH ST
SHERIDAN WY
82801-2705
US

IV. Provider business mailing address

1401 W 5TH ST
SHERIDAN WY
82801-2705
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-1000
  • Fax:
Mailing address:
  • Phone: 307-672-1046
  • Fax: 307-672-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6451
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number8052A
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number8052A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: