Provider Demographics
NPI:1659456770
Name:REDDI, JAYASREE MADI (MD)
Entity Type:Individual
Prefix:
First Name:JAYASREE
Middle Name:MADI
Last Name:REDDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CHERRY HOSPITAL
Mailing Address - Street 2:1401 WEST ASH STREET
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1078
Mailing Address - Country:US
Mailing Address - Phone:919-575-7211
Mailing Address - Fax:919-575-7643
Practice Address - Street 1:CHERRY HOSPITAL
Practice Address - Street 2:1401 WEST ASH STREET
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1078
Practice Address - Country:US
Practice Address - Phone:919-575-7211
Practice Address - Fax:919-575-7643
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC96-014502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF75561Medicare UPIN