Provider Demographics
NPI:1518504646
Name:BYREDDY, DHEERAJA REDDY (PT)
Entity Type:Individual
Prefix:MRS
First Name:DHEERAJA
Middle Name:REDDY
Last Name:BYREDDY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOLT DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1919
Mailing Address - Country:US
Mailing Address - Phone:844-777-0910
Mailing Address - Fax:
Practice Address - Street 1:11 HOLT DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1919
Practice Address - Country:US
Practice Address - Phone:844-777-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041901-12081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine