Provider Demographics
NPI:1710080130
Name:REDDY, SIRISHA P (MD)
Entity Type:Individual
Prefix:
First Name:SIRISHA
Middle Name:P
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ROBESON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5641
Mailing Address - Country:US
Mailing Address - Phone:910-484-4100
Mailing Address - Fax:910-484-4179
Practice Address - Street 1:2301 ROBESON ST STE 301
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5641
Practice Address - Country:US
Practice Address - Phone:910-484-4100
Practice Address - Fax:910-484-4179
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102395207RC0000X
WV27513207RC0000X
TXM5900207RC0000X
NC200000884207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213056Medicaid
WV3559611OtherBCBS
TX8X7818OtherBCBS
WV1710080130Medicaid
TX187364801Medicaid
TX8X7818OtherBCBS