Provider Demographics
NPI:1346350535
Name:REDDY, SUDARSANA RACHAMALLU (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDARSANA
Middle Name:RACHAMALLU
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3130 CRESCENT OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7610
Mailing Address - Country:US
Mailing Address - Phone:727-692-2310
Mailing Address - Fax:727-937-5929
Practice Address - Street 1:10,000 BAY PINES- NEUROLOGY 127
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9554
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME431342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology