Provider Demographics
NPI:1326304890
Name:REDDY, SHIVANI VARAKANTAM (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:VARAKANTAM
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 N EAGLE CREEK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1802
Mailing Address - Country:US
Mailing Address - Phone:859-263-3900
Mailing Address - Fax:859-263-3757
Practice Address - Street 1:120 N EAGLE CREEK DR STE 500
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1802
Practice Address - Country:US
Practice Address - Phone:859-263-3900
Practice Address - Fax:859-263-3757
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2022-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01087560A207W00000X
GA081424207W00000X
MA265836207W00000X
KY53509207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology