Provider Demographics
NPI:1942783600
Name:GUDURU, USHA SUNIL
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:SUNIL
Last Name:GUDURU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SHORTHORN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7743
Mailing Address - Country:US
Mailing Address - Phone:561-601-1947
Mailing Address - Fax:
Practice Address - Street 1:2013 KELLY LN
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-7879
Practice Address - Country:US
Practice Address - Phone:512-990-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily