Provider Demographics
NPI:1700851128
Name:REDDY, CHANDANA (DO)
Entity Type:Individual
Prefix:
First Name:CHANDANA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 N GREENVILLE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8622
Mailing Address - Country:US
Mailing Address - Phone:972-678-4600
Mailing Address - Fax:972-678-4602
Practice Address - Street 1:1506 N GREENVILLE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8622
Practice Address - Country:US
Practice Address - Phone:972-678-4600
Practice Address - Fax:972-678-4602
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI41504Medicare UPIN
TX8F1087Medicare ID - Type Unspecified