Provider Demographics
NPI:1316031487
Name:REDDY, JAYA (PA)
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-782-3456
Mailing Address - Fax:
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6010
Practice Address - Country:US
Practice Address - Phone:919-420-1653
Practice Address - Fax:919-788-8519
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0167GOtherBCBSNC
NC2625004OtherUHC
NC91933OtherMEDCOST
P04054Medicare UPIN
NC970013480Medicare PIN
NC0167GOtherBCBSNC