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NPI Code Detail

MEDICARE: SHREYA SHARON GONDI M.D.

MEDICARE: SHREYA SHARON GONDI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA139837CA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1770994071
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHREYA SHARON GONDI M.D.
Provider Business Mailing Address
First Line : 1800 HARRISON ST
Second Line : FL 7
City : OAKLAND
State : CA
Zip : 94612-3429
Country : US
Telephone Number : 510-625-2856
Fax Number : 877-738-4262
Provider Business Practice Location Address
First Line : 6475 CAMDEN AVE STE 107
Second Line :
City : SAN JOSE
State : CA
Zip : 95120-2847
Country : US
Telephone Number : 408-268-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2014
Last Update Date : 02/11/2022

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