Provider Demographics
NPI:1326360017
Name:CHIRRA, SURENDRANATHREDDY
Entity Type:Individual
Prefix:MR
First Name:SURENDRANATHREDDY
Middle Name:
Last Name:CHIRRA
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 1:180 ASHBURTON AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3201
Mailing Address - Country:US
Mailing Address - Phone:914-963-4525
Mailing Address - Fax:914-963-4611
Practice Address - Street 1:180 ASHBURTON AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3201
Practice Address - Country:US
Practice Address - Phone:914-963-4525
Practice Address - Fax:914-963-4611
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027703Medicaid
NY5769720001OtherDMEPOS SUPPLIER