Provider Demographics
NPI:1124594049
Name:ADMALA, SHILPA REDDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:REDDY
Last Name:ADMALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FREEMAN ST APT 502
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3566
Mailing Address - Country:US
Mailing Address - Phone:857-272-6776
Mailing Address - Fax:
Practice Address - Street 1:40 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6008
Practice Address - Country:US
Practice Address - Phone:831-724-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581521223G0001X
CA107988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice