Provider Demographics
NPI:1669678363
Name:PUTATUNDA, SHIPRA M (MD)
Entity Type:Individual
Prefix:
First Name:SHIPRA
Middle Name:M
Last Name:PUTATUNDA
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 1:1418 NORTHWOODS CV
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1130
Mailing Address - Country:US
Mailing Address - Phone:615-397-4298
Mailing Address - Fax:
Practice Address - Street 1:1418 NORTHWOODS CV
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1130
Practice Address - Country:US
Practice Address - Phone:615-397-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000257862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3088135Medicaid
TN3088135Medicare ID - Type Unspecified