Provider Demographics
NPI:1427219138
Name:SHUSHRUTHA HEDNA, VISHNUMURTHY (MD)
Entity Type:Individual
Prefix:
First Name:VISHNUMURTHY
Middle Name:
Last Name:SHUSHRUTHA HEDNA
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:812-944-7701
Mailing Address - Fax:812-981-6505
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-944-7701
Practice Address - Fax:812-981-6505
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076976A2084N0400X
KY498062084N0400X
FLME1100672084N0400X
FLTRN127042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201366510Medicaid
KY7100422930Medicaid
KY7100422930Medicaid
IN201366510Medicaid