Provider Demographics
NPI:1518528538
Name:CHENNAREDDY, ARUNATEJA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ARUNATEJA
Middle Name:
Last Name:CHENNAREDDY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 REGAL DR
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-3049
Mailing Address - Country:US
Mailing Address - Phone:732-882-9197
Mailing Address - Fax:
Practice Address - Street 1:865 STONE ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2742
Practice Address - Country:US
Practice Address - Phone:732-499-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00949700363L00000X
NJ26NR15253800163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner