Provider Demographics
NPI:1265470033
Name:REDDY, RATHIDEVI (MD)
Entity Type:Individual
Prefix:
First Name:RATHIDEVI
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 1:16901 DALLAS PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5236
Mailing Address - Country:US
Mailing Address - Phone:214-369-5522
Mailing Address - Fax:214-369-5327
Practice Address - Street 1:16901 DALLAS PKWY STE 106
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001
Practice Address - Country:US
Practice Address - Phone:214-369-5522
Practice Address - Fax:214-369-5327
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ58742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12758108Medicaid
TXF39909Medicare UPIN