Provider Demographics
NPI:1235014713
Name:RAVINDRA, SHUBHA GADDE (MD)
Entity type:Individual
Prefix:
First Name:SHUBHA
Middle Name:GADDE
Last Name:RAVINDRA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4949 W PINE BLVD APT 8J
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1474
Mailing Address - Country:US
Mailing Address - Phone:314-537-2803
Mailing Address - Fax:
Practice Address - Street 1:510 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1076
Practice Address - Country:US
Practice Address - Phone:314-362-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2025025844207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine