Provider Demographics
NPI:1619280534
Name:REDDY, NIKALESH (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKALESH
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKALESH
Other - Middle Name:
Other - Last Name:IPPAGUNTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:713 E MARION AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3862
Mailing Address - Country:US
Mailing Address - Phone:203-434-1533
Mailing Address - Fax:
Practice Address - Street 1:713 E MARION AVE STE 121
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3862
Practice Address - Country:US
Practice Address - Phone:203-434-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144107208G00000X
NY003917208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)