Provider Demographics
NPI:1558412528
Name:REDDY, LINGA VINAY (MD, PH D)
Entity Type:Individual
Prefix:DR
First Name:LINGA
Middle Name:VINAY
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:2919 W SWANN AVE STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4083
Practice Address - Country:US
Practice Address - Phone:813-872-1548
Practice Address - Fax:813-872-7509
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1229852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558412528Medicaid
WI117473601Medicare PIN
WI034868086Medicare PIN