Provider Demographics
NPI:1265054274
Name:GUNDUMALLA, MEENAKSHI RAAGALEENA (MD)
Entity type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:RAAGALEENA
Last Name:GUNDUMALLA
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 1:401 E CHESTNUT ST UNIT 600
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5705
Mailing Address - Country:US
Mailing Address - Phone:502-588-4865
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST UNIT 600
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5705
Practice Address - Country:US
Practice Address - Phone:502-588-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY591342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry