Provider Demographics
NPI:1689564551
Name:SURAPU REDDY, SHISHIRA
Entity type:Individual
Prefix:
First Name:SHISHIRA
Middle Name:
Last Name:SURAPU REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BELLAMY MILL DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4983
Mailing Address - Country:US
Mailing Address - Phone:984-500-8242
Mailing Address - Fax:
Practice Address - Street 1:10868 SOUTHERN PINES
Practice Address - Street 2:
Practice Address - City:SUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-992-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program