Provider Demographics
NPI:1578645057
Name:REDDY, SUNIL A (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:A
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 W LAS POSITAS BLVD
Mailing Address - Street 2:#100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4054
Mailing Address - Country:US
Mailing Address - Phone:925-734-8130
Mailing Address - Fax:925-225-9520
Practice Address - Street 1:5725 W LAS POSITAS BLVD
Practice Address - Street 2:#100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4054
Practice Address - Country:US
Practice Address - Phone:925-734-8130
Practice Address - Fax:925-225-9520
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61643207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H14373Medicare UPIN
00A616430Medicare ID - Type Unspecified