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Individual

SHIRISHA BODANA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121
(504) 842-4000
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121
(504) 842-4000

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
58001180
OH
207RN0300X
Nephrology Physician
Primary
DO.000149
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00729751
MS
05
1318361
LA
Enumeration date
05/25/2007
Last updated
06/11/2010
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