Provider Demographics
NPI:1033371463
Name:MEREDDY, SURESH REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:REDDY
Last Name:MEREDDY
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 1:13204 SE 306TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3278
Mailing Address - Country:US
Mailing Address - Phone:914-409-6393
Mailing Address - Fax:
Practice Address - Street 1:1414 116TH AVE NE STE F
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:425-451-8417
Practice Address - Fax:425-455-4089
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60194904207R00000X, 207RS0012X
AZR75509207QS1201X
IL036.152855207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201334401Medicaid
TX8AN226OtherBCBS OF TX
TX201334401Medicaid