Provider Demographics
NPI:1073044079
Name:REDDY, NIKHILA (MD)
Entity Type:Individual
Prefix:
First Name:NIKHILA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 CAMERON ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5836
Mailing Address - Country:US
Mailing Address - Phone:505-363-7009
Mailing Address - Fax:505-792-2057
Practice Address - Street 1:6100 PAN AMERICAN FREEWAY NE
Practice Address - Street 2:STE 390
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3401
Practice Address - Country:US
Practice Address - Phone:505-823-8599
Practice Address - Fax:505-823-8490
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2020-0131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program