Provider Demographics
NPI:1588815823
Name:REDDY, SUSHANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHANTH
Middle Name:
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 1:1922 7TH AVE S
Mailing Address - Street 2:KB 321
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2006
Mailing Address - Country:US
Mailing Address - Phone:205-934-3064
Mailing Address - Fax:
Practice Address - Street 1:1922 7TH AVE S
Practice Address - Street 2:KB 321
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2006
Practice Address - Country:US
Practice Address - Phone:205-934-3064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1742208600000X
MDD71551208600000X
AL31927208600000X
ALMD.31927208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery