Provider Demographics
NPI:1659833507
Name:DERADDO, JOSEPH SULLIVAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SULLIVAN
Last Name:DERADDO
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 1:1001 CRESCENT GRN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8101
Mailing Address - Country:US
Mailing Address - Phone:919-476-3211
Mailing Address - Fax:
Practice Address - Street 1:1001 CRESCENT GRN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8101
Practice Address - Country:US
Practice Address - Phone:919-476-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics