Provider Demographics
NPI:1710039045
Name:REDDY, SHANMUGAPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:SHANMUGAPRIYA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:GNANASHANMUGAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2779
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33568-2779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11952 BOYETTE RD
Practice Address - Street 2:SOUTHWEST FLORIDA RHEUMATOLOGY
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5601
Practice Address - Country:US
Practice Address - Phone:813-672-2243
Practice Address - Fax:813-672-2245
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96110207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90978OtherBCBS
FLAE367YMedicare PIN
FL90978OtherBCBS
FL6709210001Medicare NSC