Provider Demographics
NPI:1003830274
Name:REDDY, SYAMALA HK (MD,)
Entity Type:Individual
Prefix:DR
First Name:SYAMALA
Middle Name:HK
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 GAUSE BLVD E STE 150
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5414
Mailing Address - Country:US
Mailing Address - Phone:606-424-4767
Mailing Address - Fax:985-649-4060
Practice Address - Street 1:2050 GAUSE BLVD E STE 150
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5414
Practice Address - Country:US
Practice Address - Phone:985-629-0206
Practice Address - Fax:985-649-4060
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20922207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6420924Medicaid
1298601Medicare ID - Type Unspecified
KY6420924Medicaid