Provider Demographics
NPI:1164929923
Name:MUNDRA, LEELA S (MD)
Entity type:Individual
Prefix:
First Name:LEELA
Middle Name:S
Last Name:MUNDRA
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 1:3814 GUNN HWY STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8789
Mailing Address - Country:US
Mailing Address - Phone:303-418-2277
Mailing Address - Fax:303-418-2204
Practice Address - Street 1:36 STEELE ST STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5710
Practice Address - Country:US
Practice Address - Phone:303-418-2277
Practice Address - Fax:303-418-2204
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0074456208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery