Provider Demographics
NPI:1245218817
Name:REDDY, VENKATESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATESHA
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
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:PO BOX 2609
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-0842
Mailing Address - Country:US
Mailing Address - Phone:845-565-2477
Mailing Address - Fax:845-565-7084
Practice Address - Street 1:4 VICTORY CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1745
Practice Address - Country:US
Practice Address - Phone:845-565-2477
Practice Address - Fax:845-565-7084
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT697582084N0400X
NY1220962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00493325Medicaid
NY00493325Medicaid
NYC08049Medicare UPIN