Provider Demographics
NPI:1356503510
Name:KUNDRA, SUPERNA (MD)
Entity Type:Individual
Prefix:
First Name:SUPERNA
Middle Name:
Last Name:KUNDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13985 W GRAND AVENURE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-251-2963
Mailing Address - Fax:623-302-5793
Practice Address - Street 1:13985 W GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3625
Practice Address - Country:US
Practice Address - Phone:612-991-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN547182084P0800X
AZ485222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry