Basic Information
| Provider Information | |||||||||
| NPI: | 1942615562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASUNDRA | ||||||||
| FirstName: | SHYAM | ||||||||
| MiddleName: | PARSHOTTAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1728 COOPER BLUFF PL | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275190123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704493864 | ||||||||
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| Practice Location | |||||||||
| Address1: | 303 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386068608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625635611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 24772 | MS | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 2017-02208 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.