Provider Demographics
NPI:1811256019
Name:MUKUNDA, SHARDA (MD)
Entity type:Individual
Prefix:
First Name:SHARDA
Middle Name:
Last Name:MUKUNDA
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 1:546 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1604
Mailing Address - Country:US
Mailing Address - Phone:267-866-7211
Mailing Address - Fax:508-276-7478
Practice Address - Street 1:496 FLATBUSH AVE # C5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3702
Practice Address - Country:US
Practice Address - Phone:267-207-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262259207R00000X
PAMD464682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine