Provider Demographics
NPI:1366517617
Name:GUNDA, SHARAD V (MD)
Entity type:Individual
Prefix:DR
First Name:SHARAD
Middle Name:V
Last Name:GUNDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 HAIFLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3731
Mailing Address - Country:US
Mailing Address - Phone:337-828-4440
Mailing Address - Fax:337-828-4265
Practice Address - Street 1:606 HAIFLEIGH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3731
Practice Address - Country:US
Practice Address - Phone:337-828-4440
Practice Address - Fax:337-828-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12761R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1541192Medicaid