Provider Demographics
NPI:1194457341
Name:MANDA, PRANAY REDDY
Entity Type:Individual
Prefix:
First Name:PRANAY
Middle Name:REDDY
Last Name:MANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MADISON AVE STE 1002
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3487
Mailing Address - Country:US
Mailing Address - Phone:901-448-5529
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-3031
Practice Address - Country:US
Practice Address - Phone:901-448-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program