Provider Demographics
NPI:1609291301
Name:REDDAMMAGARI, NAGA SUNIL REDDY
Entity Type:Individual
Prefix:
First Name:NAGA SUNIL REDDY
Middle Name:
Last Name:REDDAMMAGARI
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 1:35 GRANT ST
Mailing Address - Street 2:1G
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-6400
Mailing Address - Country:US
Mailing Address - Phone:870-340-7333
Mailing Address - Fax:
Practice Address - Street 1:256 SUNSET LAKE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2847
Practice Address - Country:US
Practice Address - Phone:845-292-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist