Provider Demographics
NPI:1679885610
Name:SIDDAPUREDDY, SUNEETA (DPM)
Entity Type:Individual
Prefix:MRS
First Name:SUNEETA
Middle Name:
Last Name:SIDDAPUREDDY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 S VALLEY FORGE RD.
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19490
Mailing Address - Country:US
Mailing Address - Phone:610-584-8009
Mailing Address - Fax:
Practice Address - Street 1:2060 S VALLEY FORGE RD.
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:PA
Practice Address - Zip Code:19490
Practice Address - Country:US
Practice Address - Phone:610-584-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006228213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery