Provider Demographics
NPI:1053471342
Name:DESIREDDI, JENNIFER REILLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REILLY
Last Name:DESIREDDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3000 N INTERSTATE 35
Mailing Address - Street 2:SUITE 770
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1804
Mailing Address - Country:US
Mailing Address - Phone:512-482-8880
Mailing Address - Fax:512-482-8862
Practice Address - Street 1:3000 N INTERSTATE 35
Practice Address - Street 2:SUITE 770
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1804
Practice Address - Country:US
Practice Address - Phone:512-482-8880
Practice Address - Fax:512-482-8862
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361149492080N0001X
TXN36132080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine