Provider Demographics
NPI:1598031866
Name:REDDY, SATHAVARAM VENUDHAR
Entity Type:Individual
Prefix:MR
First Name:SATHAVARAM
Middle Name:VENUDHAR
Last Name:REDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 SW 16TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8481
Mailing Address - Country:US
Mailing Address - Phone:850-294-6809
Mailing Address - Fax:
Practice Address - Street 1:1228 SW 16TH AVE APT A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8481
Practice Address - Country:US
Practice Address - Phone:850-294-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program