Provider Demographics
NPI:1417311051
Name:YETURU, PRATHYUSHA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PRATHYUSHA
Middle Name:REDDY
Last Name:YETURU
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 1:65-11 BOOTH STREET SUITE 1C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4184
Mailing Address - Country:US
Mailing Address - Phone:718-806-1434
Mailing Address - Fax:718-806-1435
Practice Address - Street 1:65-11 BOOTH STREET SUITE 1C
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4184
Practice Address - Country:US
Practice Address - Phone:718-806-1434
Practice Address - Fax:718-806-1435
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-10
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY414716802OtherDRIVER LICENSE