Provider Demographics
NPI:1114899101
Name:BUNDOO, SHARITA S
Entity type:Individual
Prefix:
First Name:SHARITA
Middle Name:S
Last Name:BUNDOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 MATHER LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-1074
Mailing Address - Country:US
Mailing Address - Phone:812-302-2535
Mailing Address - Fax:317-252-0926
Practice Address - Street 1:7547 MATHER LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-1074
Practice Address - Country:US
Practice Address - Phone:812-302-2535
Practice Address - Fax:317-252-0926
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN25-018157-1253Z00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care