Provider Demographics
NPI:1174020358
Name:REDDY, SHILPA
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W UNIVERSITY AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3433
Mailing Address - Country:US
Mailing Address - Phone:765-747-4306
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE STE 401
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3433
Practice Address - Country:US
Practice Address - Phone:765-747-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program